Factors Affecting Prognosis and Survival in Extremity Osteosarcoma

Dharanikota, Anvesh; Arjunan, Ravi; Dasappa, Ashwathappa

doi:10.1007/s13193-020-01277-2

Cited by 8 publications

(7 citation statements)

References 37 publications

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“…We formulated and validated a prognostic score based on baseline clinical factors and tailored to a unique population of patients treated in a resource constrained setting with a non-HDMTX-based protocol. Our survival outcomes were similar to those reported in smaller studies from LMICs but still lags behind those reported from Western countries (8,20,31,32).…”

Section: Discussionsupporting

confidence: 87%

Formulation and validation of a baseline prognostic score for osteosarcoma treated uniformly with a non-high dose methotrexate-based protocol from a low middle income healthcare setting: a single centre analysis of 594 patients

et al. 2023

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IntroductionThe outcomes of osteosarcoma in low middle income countries (LMICs) are different due to patients presenting in advanced stages, resource constraints and the use of non-high-dose-methotrexate (HDMTX)-based regimens. This study derived and validated a prognostic score for osteosarcoma that integrates biologic and social factors and is tailored for patients from an LMIC setting using a non-HDMTX-based protocol.Materials and methodsA retrospective study including osteosarcoma patients enrolled for treatment at a single tertiary care centre in India between 2003-19 was conducted. Baseline biologic and social characteristics were extracted from medical records and survival outcomes were noted. The cohort was randomised into a derivation and validation cohort. Multivariable Cox regression was used to identify baseline characteristics that were independently prognostic for survival outcomes in the derivation cohort. A score was derived from the prognostic factors identified in the derivation cohort and further validated in the validation cohort with estimation of its predictive ability.Results594 patients with osteosarcoma were eligible for inclusion in the study. Around one-third of the cohort had metastatic disease with 59% of the patients residing in rural areas. The presence of metastases at baseline (HR 3.39; p<0.001; score=3), elevated serum alkaline phosphatase (SAP) >450 IU/L (HR 1.57; p=0.001; score=1) and baseline tumour size > 10 cm (HR 1.68; p<0.001; score=1) were identified to be independent factors predicting inferior event free survival (EFS) and were included in development of the prognostic score. Patients were categorized as low risk (score 0), intermediate risk (score 1-3) and high risk (4-5). Harrell’s c-indices for the score were 0.682, 0.608 and 0.657 respectively for EFS in the derivation, validation and whole cohort respectively. The timed AUC of ROC was 0.67 for predicting 18-month EFS in the derivation, validation and whole cohorts while that for 36-month EFS were 0.68, 0.66 and 0.68 respectively.ConclusionsThe study describes the outcomes among osteosarcoma patients from an LMIC treated uniformly with a non-HDMTX-based protocol. Tumor size, baseline metastases and SAP were prognostic factors used to derive a score with good predictive value for survival outcomes. Social factors did not emerge as determinants of survival.

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Section: Discussionsupporting

confidence: 87%

Formulation and validation of a baseline prognostic score for osteosarcoma treated uniformly with a non-high dose methotrexate-based protocol from a low middle income healthcare setting: a single centre analysis of 594 patients

et al. 2023

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“…En la literatura actual, se reconocen varios factores pronósticos desfavorables en osteosarcoma, tales como la presencia de metástasis al momento del diagnóstico, la respuesta insuficiente a la quimioterapia, los márgenes quirúrgicos inferiores a 2 mm y la localización en el esqueleto axial (12)(13)(14). El retraso en el diagnóstico podría explicar algunas de estas variables, como la presencia de metástasis y el tamaño tumoral en este grupo de pacientes.…”

Section: Discussionunclassified

“…El retraso en el diagnóstico podría explicar algunas de estas variables, como la presencia de metástasis y el tamaño tumoral en este grupo de pacientes. 12,13,14,15 El retraso diagnóstico y las deficiencias en el proceso de atención médica son aspectos significativos en la evolución de diversas neoplasias. En este estudio, se identificó el intervalo diagnóstico superior a cinco meses como un factor pronóstico desfavorable; tan solo dos pacientes diagnosticados después de este tiempo sobrevivieron cinco años tras el diagnóstico, con p = 0.001 (HR = 8.7; IC95%: 10.6-26.9).…”

Section: Discussionunclassified

“…El número reducido de pacientes aptos para cirugía preservadora de la extremidad se atribuye a factores como el tamaño del tumor, la presencia de múltiples metástasis tanto pulmonares como en otros órganos y el deterioro del estado general de los pacientes. 12,13,14,17 La resección amplia con reconstrucción mediante artroplastía modular fue el procedimiento quirúrgico más común, realizado en 27 (28.1%) casos. Este abordaje no sólo facilita una recuperación funcional más acelerada, sino que también alinea con las mejores prácticas actuales en el manejo del osteosarcoma.…”

Section: Variables N (%)unclassified

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Retraso en el diagnóstico de osteosarcoma en adultos: un factor pronóstico que debemos considerar

Clara-Altamirano,

García-Ortega,

Álvarez-Cano

et al. 2024

Acta Ortopédica Mexicana

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RESUMEN. Introducción: diferentes variables se han asociado con un peor pronóstico de los pacientes con osteosarcoma, destacando el tamaño tumoral, la localización en esqueleto axial y la presencia de metástasis. El objetivo de este estudio fue analizar el impacto pronóstico del retraso diagnóstico en osteosarcoma en adultos en población mexicana en un centro especializado en sarcomas. Material y métodos: estudio de tipo cohorte retrospectiva del 1 de Enero del 2005 al 31 de Diciembre de 2016, se analizaron 96 pacientes mayores de 21 años con diagnóstico de osteosarcoma. Resultados: la mediana de tiempo al diagnóstico desde el inicio de síntomas fue de seis meses (rango: 2-36). Esta variable se dicotomizó aplicando el análisis de curva dependiente de operador (ROC) y determinamos un valor de corte mayor a cinco meses con un área bajo la curva (AUC) = 0.93 [IC95% 0.86-0.97], sensibilidad 93.2% y especificidad 94.6%. Conclusión: el tiempo hasta el diagnóstico es un factor crítico en la supervivencia de los pacientes ABSTRACT. Introduction: different variables have been associated with a worse prognosis of patients with osteosarcoma (OS), highlighting tumor size, location in the axial skeleton and the presence of metastases. The objective of this study is to analyze the prognostic impact of diagnostic delay in osteosarcoma in adults in the Mexican population in a center specialized in sarcomas. Material and methods: retrospective cohort study from January 1, 2005, to December 31, 2016, 96 patients over 21 years of age with a diagnosis of osteosarcoma were analyzed. Results: the median time to diagnosis from the onset of symptoms was six months (range: 2-36). This variable was dichotomized by applying the operator-dependent curve (ROC) analysis and we determined a cut-off value greater than five months, with an area under the curve (AUC) = 0.93 [95% CI 0.86-0.97], sensitivity 93.2% and specificity 94.6%. Conclusion: time until diagnosis is a critical factor in the survival of adult patients with osteosarcoma, Retraso en el diagnóstico de osteosarcoma en adultos: un factor pronóstico que debemos considerar

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“…The factors that emerged prognostically significant for our patients were similar to those described in data from centres using HDMTX-based protocols, indicating the wide applicability of our results. For non-HDMTX regimens, particularly prevalent in LMICs, data on prognostic factors are scarce with only few observational studies [21][22][23]. Histologic response to chemotherapy has been uniformly reported to be a predictive factor in these studies.…”

Section: Metastatic Ewing's Sarcomamentioning

confidence: 99%

Prognostic Modeling for Bone Sarcomas based on a Large Prospective Cohort from a Tertiary Care Cancer Centre in India

Sarkar,

Bajpai,

Rath

et al. 2024

Preprint

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Background: Outcomes of adolescents and young adults (AYA) with bone sarcomas inclusive of osteosarcoma (OGS) and Ewing’s sarcoma (ES) are impacted by various factors including inadvertent prior treatment and poor compliance. We aimed to identify prognostic factors and derive prognostic models for these patients. Methods: All AYA OGS and ES cases treated at our institute with the “OGS-12” and Ewing’s family of tumors-2001 (“EFT-2001”) protocols from 2011 to 2021, and 2013 to 2018 respectively, were prospectively analyzed. Results:. Among 606/748 (81.0%) AYA with non-metastatic osteosarcoma, significant factors included in the prognostic model were failure to complete protocol (hazard ratio (HR) 2.65, 95% confidence interval (CI) 1.65-4.26), prior treatment (HR 2.93, CI 1.4-6.1), necrosis <90% (HR 1.63, CI 1.24-2.1), joint involvement (HR 2.0, CI 1.49-2.69) and SAP> median (204 U/l) (HR 1.63, CI 1.24-2.14). Of 104/263 (39.5%) AYA ES, significant factors were failure to complete protocol (HR 2.84, CI 1.03-7.8), prior treatment (HR 6.37, CI 1.8-22.0), necrosis <100% (HR 8.73, CI 2.16-35.3), and tumor size >8cm (HR 2.64, CI 1.04-6.7). For 142/366 (38.8%) AYA with metastatic OGS, significant factors were failure to complete protocol (HR 5.29), metastases not amenable to local treatment (HR 1.96), necrosis <90% (HR 1.96), and >10 metastases (HR 2.44). For 38/82 (43.6%) AYA with metastatic extremity ES, significant factors were failure to complete protocol (HR 3.88) and metastases not amenable to local treatment (HR 10.6). Conclusion: We developed simple, effective prognostic models for AYA with bone sarcomas with wide applicability in LMIC.

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Factors Affecting Prognosis and Survival in Extremity Osteosarcoma

Cited by 8 publications

References 37 publications

Formulation and validation of a baseline prognostic score for osteosarcoma treated uniformly with a non-high dose methotrexate-based protocol from a low middle income healthcare setting: a single centre analysis of 594 patients

Formulation and validation of a baseline prognostic score for osteosarcoma treated uniformly with a non-high dose methotrexate-based protocol from a low middle income healthcare setting: a single centre analysis of 594 patients

Retraso en el diagnóstico de osteosarcoma en adultos: un factor pronóstico que debemos considerar

Prognostic Modeling for Bone Sarcomas based on a Large Prospective Cohort from a Tertiary Care Cancer Centre in India

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