Prognostic value of pathologic fracture in patients with high grade localized osteosarcoma: A systemic review and meta‐analysis of cohort studies

Abstract

Consensus has not been reached regarding the ability of pathologic fracture to predict local recurrence and survival in osteosarcoma. We aim to review the available evidence to examine the association between pathologic fracture and osteosarcoma prognosis. A comprehensive literature search for relevant studies published until March 2014 was performed using PubMed, Cochrane and Web of Science. The studies investigating pathologic fracture of osteosarcoma patients were systematically analyzed. The overall relative risk (RR) was estimated using a fixed-effect model or random-effect model according to heterogeneity between the trials. We included nine cohort studies involving 2,187 patients (311 with pathologic fracture and 1,876 without fracture) for the analysis of survival rate and local recurrence. Studies were assessed for quality using the Newcastle-Ottawa Assessment Scale. In the fixed-effects model, the meta-analysis showed that pathologic fracture in osteosarcoma patients predicted poor 3-year overall survival (OS) (RR ¼ 1.86, 95% CI: 1.37-2.53, p < 0.001) and 5-year OS (RR ¼ 1.34, 95% CI: 1.06-1.70, p ¼ 0.016). Similarly, pathologic fracture was significantly correlated with worse 3-year event free survival (EFS) (RR ¼ 1.52, 95% CI: 1.21-1.92, p < 0.001) and 5-year EFS (RR ¼ 1.24, 95% CI: 1.03-1.49, p ¼ 0.021), whereas no significant association was noted with local recurrence (RR ¼ 1.30, 95% CI: 0.84-2.02, p ¼ 0.233). The meta-analysis confirmed that pathologic fracture in osteosarcoma was a prognostic marker for both OS and EFS but not for local recurrence. ß

Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients

“…In contrast to most other studies, this study demonstates a higher incidence of local recurrences in patients with OS and PF [13-15, 18, 29-31, 34]. We hereby corroborate the data of Scully et al [28] who observed a significantly higher rate of local recurrences in patients with PF.…”

“…Ryan et al [16] observed a significantly lower 5-year survival rate in a very small group of 5 pediatric patients with OS and PF compared to 10 pediatric patients in the nonfracture group (40 vs. 80%). In a large meta-analysis of 2,187 patients with OS of the extremities, Sun et al [29] found a statistically significantly better survival in patients without PF. However, other data did not corroborate this correlation [15, 30, 31].…”

Pathologic fracture in childhood and adolescent osteosarcoma: A single-institution experience

“…Two prominent studies stated that pathologic fracture was significantly associated with an increased local recurrence rate . However, multiple recent studies have contradicted their results . Our results support these more recent studies.…”

“…Scully et al., Bramer et al., Coley et al., Ferguson et al., Lee et al., and Sun et al. have reported a decrease in overall survival in pathologic fracture patients . They attributed this to tumor dissemination.…”

Regulatory role of microRNA184 in osteosarcoma cells

“…Osteosarcoma progresses and metastasizes quickly, and is resistant to chemotherapy. Due to its high mortality rate, it can cause great pain and heavy economic burden to the patient and family (Ebrahimzadeh et al, 2013;Sun et al, 2015).…”