The Epidemiology of Osteosarcoma

Abstract

Osteosarcoma derives from primitive bone-forming mesenchymal cells and is the most common primary bone malignancy. The incidence rates and 95% confidence intervals of osteosarcoma for all races and both sexes are 4.0 (3.5-4.6) for the range 0-14 years and 5.0 (4.6-5.6) for the range 0-19 years per year per million persons. Among childhood cancers, osteosarcoma occurs eighth in general incidence and in the following order: leukemia (30%), brain and other nervous system cancers (22.3%), neuroblastoma (7.3%), Wilms tumor (5.6%), Non-Hodgkin lymphoma (4.5%), rhabdomyosarcoma (3.1%), retinoblastoma (2.8%), osteosarcoma (2.4%), and Ewing sarcoma (1.4%). The incidence rates of childhood and adolescent osteosarcoma with 95% confidence intervals areas follows: Blacks, 6.8/year/million; Hispanics, 6.5/year/million; and Caucasians, 4.6/year/million. Osteosarcoma has a bimodal age distribution, having the first peak during adolescence and the second peak in older adulthood. The first peak is in the 10-14-year-old age group, coinciding with the pubertal growth spurt. This suggests a close relationship between the adolescent growth spurt and osteosarcoma. The second osteosarcoma peak is in adults older than 65 years of age; it is more likely to represent a second malignancy, frequently related to Paget's disease. The incidence of osteosarcoma has always been considered to be higher in males than in females, occurring at a rate of 5.4 per million persons per year in males vs. 4.0 per million in females, with a higher incidence in blacks (6.8 per million persons per year) and Hispanics (6.5 per million), than in whites (4.6 per million). Osteosarcoma commonly occurs in the long bones of the extremities near the metaphyseal growth plates. The most common sites are the femur (42%, with 75% of tumors in the distal femur), the tibia (19%, with 80% of tumors in the proximal tibia), and the humerus (10%, with 90% of tumors in the proximal humerus). Other likely locations are the skull or jaw (8%) and the pelvis (8%). Cancer deaths due to bone and joint malignant neoplasms represent 8.9% of all childhood and adolescent cancer deaths. Death rates for osteosarcoma have been declining by about 1.3% per year. The overall 5-year survival rate for osteosarcoma is 68%, without significant gender difference. The age of the patient is correlated with the survival, with the poorest survival among older patients. Complete surgical excision is important to ensure an optimum outcome. Tumor staging, presence of metastases, local recurrence, chemotherapy regimen, anatomic location, size of the tumor, and percentage of tumor cells destroyed after neoadjuvant chemotherapy have effects on the outcome.

Surgical Technique: Computer-generated Custom Jigs Improve Accuracy of Wide Resection of Bone Tumors

“…For instance, the surgeon may inadvertently cut into the tumor during surgery. In the case of an osteogenic sarcoma [24], such imprecision can increase rates of local recurrence and mortality [3][4][5]23]. Alternatively, the surgeon may opt to resect substantially more normal tissue to avoid tumor disruption.…”

TNFα promotes osteosarcoma progression by maintaining tumor cells in an undifferentiated state

“…4 Osteosarcoma is a rare malignancy but the most common bone sarcoma in children and adolescents. 5 Osteosarcoma frequently metastasizes to tissues such as lung, leading to mortality. 6 As osteosarcoma develops in young people free from chronic inflammation, tumor progression has been considered independent of inflammation.…”

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

“…Because tumors of the proximal tibia are relatively rare, our study group was relatively small [13,22,32]. Thus, we were unable to include a control group in which another surgical technique could have been used [12,40,41].…”

“…The proximal tibia is a rarely affected site of primary malignant bone tumors [13,22,32]. At this location, the patellar tendon often has to be resected together with the tumor [5,24,37].…”