A comparative study between limb-salvage and amputation for treating osteosarcoma

Abstract

PurposeOsteosarcoma is an aggressive malignant neoplasm, and conflicting findings have been reported on the survival and function recovery in osteosarcoma patients experiencing limb salvage or amputation. In the present study, we compared clinical outcomes regarding limb salvage surgery vs. amputation for osteosarcoma patients by a meta-analysis.MethodLiterature search was conducted in CNKI, Medline, Embase, the Cochrane Database, and Web of Sciences, and the quality of included studies was evaluated based on Newcastle-Ottawa scale quality assessment. Odds ratio and 95% confidence interval of the local recurrence, 5-year overall survival, and metastasis occurrence were calculated.Results17 articles were included according to selection criteria. There were 1343 patients in total derived from these studies. Our result showed that there was no significant difference between limb salvage surgery and amputation with respect to local recurrence, and patients with limb salvage surgery had a higher 5-year overall survival, and a lower metastasis occurrence.ConclusionsThe present study provided more comprehensive evidences to support limb salvage surgery as an optimal treatment of osteosarcoma patients.

A meta-analysis of randomized control trials of surgical methods with osteosarcoma outcomes

“…In the meta-analysis, we found that LSS had a similar 5-year survival compared with those treated with amputation. However, after excluding the three studies [9, 14, 25], which may be the main source of the heterogeneity and whose subjects were Asian, we found the heterogeneity reducing notably and P value ( P  = 0.0001) in the comparison of LSS with amputation, which proved that 5-year overall survival rate of patients treated with LSS was higher than those treated with amputation. Then in the heterogeneity test, we found that there was apparent heterogeneity among all of the eligible studies.…”

“…Statistical heterogeneity among the included studies was evaluated by the I 2 tests. Statistically significant heterogeneity was defined as an I 2 value >0.5 [9]. I 2 illustrates the percentage of the total variability in effect estimates among trials that is due to heterogeneity rather than to chance.…”

“…Consequently, amputation is considered to be a better option for osteosarcoma patients with pathologic fracture [7, 8]. It has been reported that the risk of local recurrence and the 5-year OS rate did not differ significantly between LSS and amputation in osteosarcoma patients with pathological fractures [9]. Han et al has reported that the risk of local recurrence and the 5-year OS rate did not differ significantly between LSS and amputation in osteosarcoma patients [10].…”

Review of Osteosarcoma and Current Management

“…In the Rizzoli study, recurrence correlated closely with margin status and tumor grade, showing that the quality of resection and underlying tumor biology are the most important factors in recurrence, not surgery type. The safety of limb preservation has been confirmed many times, with the most recent being a meta-analysis including over 1300 patients [96, 100–102]. Local recurrence was equal for amputation and limb salvage, and patients with limb salvage actually had a higher 5-year survival [100].…”

“…The safety of limb preservation has been confirmed many times, with the most recent being a meta-analysis including over 1300 patients [96, 100–102]. Local recurrence was equal for amputation and limb salvage, and patients with limb salvage actually had a higher 5-year survival [100]. For these reasons, amputation is generally reserved only for those tumors in which a resection to disease-free margins is not possible without creating a nonfunctional limb [94].…”