Prognostic factors for teenage and adult patients with high-grade osteosarcoma: an analysis of 240 patients

Abstract

The aim of this retrospective, multicenter study was to evaluate clinicopathological characteristics, prognostic factors and treatment outcomes of teenage and adult patients with high-grade osteosarcoma. A total of 240 osteosarcoma patients who were diagnosed and treated from March 1995 to September 2011 were analyzed. Median age was 20 years (range 13-74 years), and 153 patients (63.8%) were male. Primary tumor localization was extremity in 204 patients (85.4 %), trunk in 21 patients (8.8%) and head and neck region in 14 patients (5.9%). According to American Joint Committee on Cancer staging system, 186 patients (77.5%) were stage II, 3 (1.3%) were stage III and 48 (20.0%) were stage IV. Median overall survival (OS) was 55 months (95 % CI 36.8-73.1 months). OS after 2, 5 and 10 years were 67, 49 and 42%, respectively. Univariable analysis for OS showed that male gender (p = 0.032), high baseline lactate dehydrogenase (LDH) level (p < 0.001), high baseline serum alkaline phosphatase level (p = 0.002), telangiectatic subtype (p = 0.023), presence of metastasis at diagnosis (p < 0.001), presence of tumor positive margins after primary surgery (p = 0.015), poor pathological response to preoperative chemotherapy (p = 0.006) and presence of recurrent disease during follow-up period (p < 0.001) were significantly associated with poor survival. Patients who received postoperative methotrexate plus doxorubicin plus cisplatin (M + A + P) combination regimen (p = 0.019), underwent surgery for recurrent disease (p < 0.001) and received chemotherapy for recurrent disease (p < 0.001) had longer OS. In multivariable analysis for OS, only high LDH level (p = 0.002) and the presence of metastasis at diagnosis (p = 0.011) were associated with poor OS, whereas the patients who received chemotherapy for recurrent disease had a longer OS (p = 0.009).

Sinomenine prevents metastasis of human osteosarcoma cells via S phase arrest and suppression of tumor-related neovascularization and osteolysis through the CXCR4-STAT3 pathway

“…Thus, ALP is adopted as clinically meaningful marker in diagnosis and predicting prognosis in osteosarcoma (39,40). Serum LDH are also known to reflect the tumor burden and associated with poor prognosis (41). Decrease of ALP or LDH levels may be a symptom of a positive reaction to treatment.…”

Osteosarcoma

“…However, it is prudent to obtain them to establish baseline levels, specifically a complete blood count, metabolic profile, alkaline phosphatase, and serum lactate dehydrogenase. Alkaline phosphatase and serum lactate dehydrogenase can be trended during the treatment and some studies have suggested a negative prognosis if they are elevated at baseline [37,38].…”

Osteosarcoma: Diagnostic dilemmas in histopathology and prognostic factors

“…Up to 20% OS patients have evidence of metastases at their initial presentation. The risk of mortality is significantly more in those with metastases at initial presentation 303138415253. They are also likely to have shorter EFS than their counterparts with limited disease 2841.…”