A Retrospective Clinicopathological Study of Osteosarcoma Patients with Metachronous Metastatic Relapse

Abstract

Purpose : Although osteosarcoma patients receive a standardized treatment, metachronous metastatic relapse still impairs the overall survival (OS). This study aimed to explore the clinicopathological features and prognostic factors of osteosarcoma patients with metachronous metastatic relapse. Patients and methods : We retrospectively analyzed 59 patients, between January 1st, 2004 and December 31st, 2013. Employed Chi-square test to recognize the differences in clinicopathological characteristics between early and late metastatic patients, and the differences between shorter and longer survival patients. Used the Kaplan-Meier method to evaluate the survival data, cox step proportional hazard test to analyze the prognostic factors associated with OS. Results : We found that early metastatic patients were prominently correlated with the male, tumor size ≥8 cm, histological grade G2, Enneking stages II, anatomic location of the distal femur, pathological of conventional types, and elevated alkaline phosphatase (ALP) level at diagnosis, (p<0.05). In parallel, the shorter survival patients were primarily linked to tumor size ≥8 cm, histological grade G2, Enneking stages II, early metastasis, multiple pulmonary metastases, lack of curative treatment after metastasis, increased level of ALP at diagnosis and LDH after metastasis, (p<0.05). The univariate analyses of the prognostic factors showed that patients who had these clinicopathological characteristics, such as male, tumor size ≥8 cm, Enneking stage IIB, multiple pulmonary metastases, lack of curative treatment after metastasis, the elevated ALP at diagnosis, elevated ALP and LDH after metastasis, had a worse OS in osteosarcoma patient with metachronous metastatic relapse, (p<0.05). The multivariate analyses showed that tumor size, type of metastasis and ALP level at diagnosis were independent factors for OS in osteosarcoma patient with metachronous metastatic relapse (p<0.05). Conclusion : These results indicated that osteosarcoma patients with metachronous metastatic relapse have special features which might be utilized to effectively predict the likelihood of early metastatic relapse and the prognosis.

Metastatic Progression of Osteosarcomas: A Review of Current Knowledge of Environmental versus Oncogenic Drivers

“…The risk factors for lung metastasis after treatment are male sex, tumor size ≥8 cm, histological grade G2, Enneking stage II, anatomic location to the distal femur, pathological subtype (conventional osteosarcoma), and high level of alkaline phosphatase at diagnosis [ 36 ]. The prognostic factors associated with better survival are the timing of metastasis [ 35 ], younger age (<60 years old), and surgical treatment of the primitive tumor [ 7 ].…”

“…The prognostic factors associated with better survival are the timing of metastasis [ 35 ], younger age (<60 years old), and surgical treatment of the primitive tumor [ 7 ]. The prognostic factors associated with short survival are primitive tumor size (>3 or 8 cm), histological subtype (chondroblastic versus osteoblastic), histological grade G2, Enneking stage II, early metastasis, local recurrence before metastasis, extrapulmonary metastasis, multiple pulmonary metastases, poor response to primary chemotherapy, lack of curative treatment after metastasis, including metastasectomy, increased level of alkaline phosphatase at diagnosis and lactate dehydrogenase after metastasis [ 5 , 36 , 37 , 38 ].…”

Functional interplay between long non-coding RNAs and the Wnt signaling cascade in osteosarcoma

“…Moreover, it is of great necessity to further validate the sensitivity and specificity of lncRNAs as biomarkers in clinical settings. Established serum markers, such as alkaline phosphatase (ALP) and lactate dehydrogenase (LDH), have been widely adopted to aid in diagnosing osteosarcoma for decades [ 185 , 186 ], and whether these Wnt-related lncRNAs have more advantages over these markers need to be further verified. Due to the easy accessibility and routine availability, the Wnt signaling-related lncRNAs with excellent diagnostic performance may be promising candidates in near future.…”

Targeting Akt/NF-κB/p53 Pathway and Apoptosis Inducing Potential of 1,2-Benzenedicarboxylic Acid, Bis (2-Methyl Propyl) Ester Isolated from Onosma bracteata Wall. against Human Osteosarcoma (MG-63) Cells

“…OS generally develops via cell proliferation perturbation, dysregulation of cell cycle, and mutations in DNA, and around 70% of osteosarcoma cases showed chromosomal aberrations [ 3 ]. Existing chemo-therapeutic medication does not show a significant effect in combating cancer [ 4 , 5 ]. Although there are a variety of modern treatment strategies available for treating cancer, these strategies still have limitations such as re-occurrence, metastasis, low success rate, and several side effects [ 6 , 7 ].…”