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Comparative Study
. 2018 Feb 23;16(1):39.
doi: 10.1186/s12957-018-1344-3.

The extremity localized classic osteosarcomas have better survival than the axial non-classics

Li Lin  1 , Shaoyong Deng  2 , Futing Zhang  1 , Yaoze Liang  3 , Zhenhua Huang  4
Affiliations
Comparative Study

The extremity localized classic osteosarcomas have better survival than the axial non-classics

Li Lin et al. World J Surg Oncol. .

Abstract

Background: Osteosarcoma is one of the most malignant primary bone cancers, while is rarely reported in China. Of note, very few data of prognosis has been documented in this region. Thus, we carried a retrospective study to identify prognostic factors and to analyze outcomes in patients of both classic and non-classic high-grade osteosarcomas. Classic osteosarcoma is defined as of high-grade histology, age below 40 years, with extremity localized primary tumor, and without detectable metastasis at primary diagnosis.

Methods: A total of 98 patients (68 classic and 30 non-classic) aged from 4 to 64 years old were diagnosed as high-grade osteosarcoma from 2008 to 2015 in Nanfang Hospital, Guangzhou, China. Univariate and multivariate analyses were performed to identify the independent predictors for overall survival and event-free survival. Kaplan-Meier method was used for survival analysis.

Results: The median overall survival was 117 vs. 21 months, and the median event-free survival was 31 vs. 6 months in classic and non-classic osteosarcoma, respectively. The most frequently found tumor site was around the knee. The classic osteosarcoma had better overall survival and event-free survival than the non-classics. Tumor site and primary metastasis were found to be associated with overall survival and event-free survival in the univariate analysis. In the multivariate Cox regression analysis, tumor site and primary metastasis were each verified as independent prognostic factors. However, no similar result was found in elevated serum alkaline phosphatase or lactate dehydrogenase. Amputation or limb salvage surgery had no significant effect on overall survival and event-free survival in the extremity osteosarcomas. Classic osteosarcomas with extremity tumor site and free of primary metastasis exhibited better overall survival and event-free survival, while the axial and metastatic non-classics exhibited the worse.

Conclusions: The extremity classic osteosarcomas have better survivals than the axial non-classic cases. Amputation and limb salvage surgery make no significant change in overall survival and event-free survival in the extremity osteosarcomas.

Trial registration: Nanfang2013071; Date of registration: 7 September 2013 (retrospectively registered).

Keywords: Axial; Event-free survival; Extremity; Osteosarcoma; Overall survival.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Nanfang Hospital Ethics Review Board with the consent of each patient.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Representative hematoxylin-eosin staining of classic and non-classic high-grade osteosarcomas in this study. b Schematic figure showing the distribution of classic and non-classic high-grade osteosarcoma patients of this study. The three intersecting circles comprised age ≤ 40 years, extremity localized primary tumor, or free of metastasis at primary diagnosis, to illustrate the overlapping parts between the three elements of the definition of classic osteosarcoma
Fig. 2
Fig. 2
a Survival curves of OS and EFS in all osteosarcoma patients in this study. b OS and c EFS curves of the classic and non-classic osteosarcomas.
Fig. 3
Fig. 3
Survival curves of a, c OS and b, d EFS in the osteosarcomas. Patients are categorized by classic or non-classic combined with (a and b) primary tumor location or (c and d) metastatic status
See this image and copyright information in PMC

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