Pathological fracture as the presenting feature in pediatric osteosarcoma

Lee, Ryan K. L.; Chu, Winnie C.W.; Leung, Justin; Cheng, Frankie Wai Tsoi; Li, Chi Kong

doi:10.1002/pbc.24447

Cited by 18 publications

(33 citation statements)

References 15 publications

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“…This result is consistent with the findings of most other authors [14, 15, 30, 31]. In contrast, recent data demonstrated a higher rate of metastases in patients with OS and PF [16, 32]. …”

Section: Discussionsupporting

confidence: 68%

“…We hereby corroborate the data of Scully et al [28] who observed a significantly higher rate of local recurrences in patients with PF. However, it is of note that in our study the rate of amputation is only 9%, while other authors report on rates between 20 and 60% [14, 16, 18, 31, 28]. Furthermore, other studies report on higher rates of amputation in the fracture group compared to the nonfracture group [14, 30], which is not consistent with our findings (Table 2).…”

Section: Discussioncontrasting

confidence: 57%

“…Bramer et al [18] found a higher mortality rate in patients with localized OS of the extremities who sustained PF (10-year survival rate of 34 vs. 55%). Ryan et al [16] observed a significantly lower 5-year survival rate in a very small group of 5 pediatric patients with OS and PF compared to 10 pediatric patients in the nonfracture group (40 vs. 80%). In a large meta-analysis of 2,187 patients with OS of the extremities, Sun et al [29] found a statistically significantly better survival in patients without PF.…”

Section: Discussionmentioning

confidence: 99%

“…Another theory hypothesizes that PF is a symptom of a more aggressive tumor with lytic bone destruction leading subsequently to a higher risk of PF [16, 17, 33]. According to Moradi et al [33], PF occurs more frequently in patients with higher tumor stages IIa/b and III.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients

et al. 2018

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Background: The purpose of this study was to investigate whether pathological fractures (PF) influence the prognosis of patients with osteosarcoma (OS) or Ewing tumor (ET) regarding 5-year survival, occurrence of metastases, and local recurrence. Methods: We retrospectively analyzed 205 patients with metastatic and nonmetastatic OS or ET. Survival analysis was performed for all patients and differentiated for patients with OS (n = 127) and ET (n = 78) as well as for adults (n = 101) and children (n = 104). Results: Patients with PF showed survival rates of 64% compared to 83% for those without PF (p = 0.023). Local recurrence occurred in 7% of the patients without and in 24% of those with PF (p = 0.023). In patients with ET and in children, survival analysis showed no significant difference between patients with and without PF in survival and local recurrence rates. In patients with OS, survival rate decreased from 83 to 59% (p = 0.024) and local recurrence rate increased from 13 to 30% (p = 0.042). In adults, survival rate decreased from 78 to 51% (p = 0.004) and local recurrence rate increased from 13 to 42% (p < 0.001). In multivariate analysis, age and PF were associated with inferior survival. Conclusion: This study suggests that the occurrence of PF has a negative impact on survival and implicates an increased risk of local recurrence. In children and in patients with ET, PF did not have a prognostic impact.

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“…This result is consistent with the findings of most other authors [14, 15, 30, 31]. In contrast, recent data demonstrated a higher rate of metastases in patients with OS and PF [16, 32]. …”

Section: Discussionsupporting

confidence: 68%

Section: Discussioncontrasting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients

et al. 2018

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“…However, metaphyseal osteosarcoma in children has been widely considered as a contraindication for limb salvage surgery (2). First, pathological fracture results in loss of the surgical border of the tumor; thus, radical or wide resection cannot be performed (5,6). Second, reconstruction with prosthetic replacement is not suitable for children who have yet to reach skeletal maturity.…”

Section: Introductionmentioning

confidence: 99%

Effect of pathological fracture on limb salvage surgery with preservation of the epiphysis in children with osteosarcoma of the distal femur: Two case reports

Zheng

Chang

et al. 2016

Molecular and Clinical Oncology

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Abstract. The outcome of limb salvage treatment for femoral osteosarcoma with pathological fractures in children is currently unknown. The aim of the present study was to present two cases of patients who received limb salvage surgery with preservation of the epiphysis at the Department of Orthopedics of The General Hospital of Jinan Military Commanding Region (Shandong, China). Between January, 2007 and January, 2013, two pediatric patients were admitted to our hospital with pathological fractures. One of the patients was a girl, aged 11 years, with confirmed osteosarcoma of the right distal femur; the other patient was a boy, aged 9 years, with osteosarcoma of the left distal femur. After receiving two cycles of neoadjuvant chemotherapy following tumor biopsy, the patients received limb salvage surgery with epiphyseal preservation, with wide resection of the tumor and biological reconstruction by allogeneic bone and fibular autograft, followed by 10 cycles of adjuvant chemotherapy. With a mean follow-up of 64 months, there were no postoperative complications, local recurrence or metastasis. The limb function recovered well, although limb shortening was observed. The female patient underwent a second fixation and limb lengthening after epiphyseal closure. Therefore, with effective neoadjuvant chemotherapy, limb salvage surgery with epiphyseal preservation is not contraindicated for pediatric patients with pathological fractures from femoral osteosarcoma. Biological reconstruction by allogeneic bone and vascularized fibular autograft following wide tumor resection is a viable option for such patients, with a good postoperative functional outcome.

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Prognostic value of pathologic fracture in patients with high grade localized osteosarcoma: A systemic review and meta‐analysis of cohort studies

Sun

Zhang

et al. 2014

Journal Orthopaedic Research

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Consensus has not been reached regarding the ability of pathologic fracture to predict local recurrence and survival in osteosarcoma. We aim to review the available evidence to examine the association between pathologic fracture and osteosarcoma prognosis. A comprehensive literature search for relevant studies published until March 2014 was performed using PubMed, Cochrane and Web of Science. The studies investigating pathologic fracture of osteosarcoma patients were systematically analyzed. The overall relative risk (RR) was estimated using a fixed-effect model or random-effect model according to heterogeneity between the trials. We included nine cohort studies involving 2,187 patients (311 with pathologic fracture and 1,876 without fracture) for the analysis of survival rate and local recurrence. Studies were assessed for quality using the Newcastle-Ottawa Assessment Scale. In the fixed-effects model, the meta-analysis showed that pathologic fracture in osteosarcoma patients predicted poor 3-year overall survival (OS) (RR ¼ 1.86, 95% CI: 1.37-2.53, p < 0.001) and 5-year OS (RR ¼ 1.34, 95% CI: 1.06-1.70, p ¼ 0.016). Similarly, pathologic fracture was significantly correlated with worse 3-year event free survival (EFS) (RR ¼ 1.52, 95% CI: 1.21-1.92, p < 0.001) and 5-year EFS (RR ¼ 1.24, 95% CI: 1.03-1.49, p ¼ 0.021), whereas no significant association was noted with local recurrence (RR ¼ 1.30, 95% CI: 0.84-2.02, p ¼ 0.233). The meta-analysis confirmed that pathologic fracture in osteosarcoma was a prognostic marker for both OS and EFS but not for local recurrence. ß

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Pathological fracture as the presenting feature in pediatric osteosarcoma

Abstract: Osteosarcoma complicated by pathological fracture as first presentation had higher incidence of lung and bone metastases at presentation and worse survival rate when compared with patients without pathological fracture.

Cited by 18 publications

References 15 publications

Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients

Impact of Pathological Fractures on the Prognosis of Primary Malignant Bone Sarcoma in Children and Adults: A Single-Center Retrospective Study of 205 Patients

Effect of pathological fracture on limb salvage surgery with preservation of the epiphysis in children with osteosarcoma of the distal femur: Two case reports

Prognostic value of pathologic fracture in patients with high grade localized osteosarcoma: A systemic review and meta‐analysis of cohort studies

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