Preoperative surgical risk stratification in osteosarcoma based on the proximity to the major vessels

Abstract

Aims The aim of this study was to determine the risk of local recurrence and survival in patients with osteosarcoma based on the proximity of the tumour to the major vessels. Patients and Methods A total of 226 patients with high-grade non-metastatic osteosarcoma in the limbs were investigated. Median age at diagnosis was 15 years (4 to 67) with the ratio of male to female patients being 1.5:1. The most common site of the tumour was the femur (n = 103) followed by tibia (n = 66). The vascular proximity was categorized based on the preoperative MRI after neoadjuvant chemotherapy into four types: type 1 > 5 mm; type 2 ≤ 5 mm, > 0 mm; type 3 attached; type 4 surrounded. Results Limb salvage rate based on the proximity type was 92%, 88%, 51%, and 0% for types 1 to 4, respectively, and the overall survival at five years was 82%, 77%, 57%, and 67%, respectively (p < 0.001). Local recurrence rate in patients with limb-salvage surgery was 7%, 8%, and 22% for the types 1 to 3, respectively (p = 0.041), and local recurrence at the perivascular area was observed in 1% and 4% for type 2 and 3, respectively. The mean microscopic margin to the major vessels was 6.9 mm, 3.0 mm, and 1.4 mm for types 1 to 3, respectively. In type 3, local recurrence-free survival with limb salvage was significantly poorer compared with amputation (p = 0.025), while the latter offered no overall survival benefit. In this group of patients, factors such as good response to chemotherapy or limited vascular attachment to less than half circumference or longitudinal 10 mm reduced the risk of local recurrence. Conclusion The proximity of osteosarcoma to major blood vessels is a poor prognostic factor for local control and survival. Amputation offers better local control for tumours attached to the blood vessels but does not improve survival. Limb salvage surgery offers similar local control if the tumour attachment to blood vessels is limited. Cite this article: Bone Joint J 2019;101-B:1024–1031.

Limb-salvage surgery offers better five-year survival rate than amputation in patients with limb osteosarcoma treated with neoadjuvant chemotherapy. A systematic review and meta-analysis

“…One hundred and seven articles were excluded based on the inclusion criteria, while 23 articles were excluded, as they studied the same patient population, estimated from the institution, number of patients and name of the authors. At last, 13 articles met the inclusion criteria and were eligible for analysis [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] . Screening and selection details are depicted in Fig.…”

“…We included 12 studies [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [27] analyzing the 5-year overall survival rate in 2826 patients; 1943 patients were treated with LSS and 883 with amputation. The overall pooled analysis demonstrated that the odds of 5-year overall survival was almost 2-fold in patients treated with LSS than those treated with amputation but with substantial heterogeneity (OR: 1.99; 95% CI: 1.35–2.93; I 2 = 74%, p < 0.001) ( Fig.…”

“…A total of six studies [15] , [18] , [21] , [23] , [24] , [26] , involving 1139 patients evaluated the 5-year DFS of patients with limb osteosarcoma; 873 patients were treated with LSS and 266 with amputation. The pooled analysis showed that the 5-year DFS was not different between those treated with LSS and those treated with amputation (OR: 1.24; 95% CI: 0.55–2.79; I 2 = 67%, p = 0.01) ( Fig.…”

Clinical features and outcomes of primary bone and soft tissue sarcomas in adolescents and young adults

“…In general, surgical margins are associated with the prognosis of malignant bone and soft tissue tumors (24,25). Previous findings demonstrated that the surgical margin is associated with the prognosis of malignant bone and soft tissue tumors in AYA patients (26).…”

Intraoperative considerations in a patient with chondroblastic osteosarcoma and saddle pulmonary embolism undergoing amputation

“…4 High-grade/metastatic osteosarcoma is typically treated with chemotherapy prior to surgical resection if applicable. 5 In localized nonmetastatic disease, the long-term survival is 70%-75% but it drops to only 30% when it is invasive or has metastatic lesions. 6 The use of intraoperative transesophageal echo (TEE) in noncardiac surgery is growing as anesthesiologists have identified other applications and benefits.…”