Prevalence of Metastasis at Diagnosis of Osteosarcoma: An International Comparison

Abstract

Background Osteosarcoma is the most common primary malignant bone tumor in many countries, with metastatic disease responsible for most patient deaths. This study compares the prevalence of metastatic osteosarcoma at diagnosis across countries to inform the critical question of whether diagnostic delay or tumor biology drives metastases development prior to diagnosis. Procedure A literature search of the PubMed database was conducted to compare the prevalence of metastatic disease at the time of OS diagnosis between countries. A pooled prevalence with 95% confidence intervals was calculated for each study meeting inclusion criteria. Studies were grouped for analysis based on human development index (HDI) scores. Results Our analysis found an 18% (95% CI: 15%, 20%) average global pooled proportion of metastasis at osteosarcoma diagnosis. The average prevalence of metastasis at diagnosis increased as HDI groupings decreased, with very high HDI, high HDI, and medium/ low HDI groups found to be 15% (95% CI: 13%, 17%), 20% (95% CI: 14%, 28%), and 31% (95% CI: 15%, 52%), respectively. Conclusions Our evidence suggests there is a biological baseline for metastatic OS at diagnosis, which is observed in countries with very high HDI. In countries with medium/ low HDI, where there are more barriers to accessing healthcare, the higher prevalence of metastasis may result from treatment delay or an artificial prevalence inflation due to patients with less severe symptoms not presenting to clinic. Additional research in countries with medium/ low HDI may reveal that earlier detection and treatment could improve patient outcomes in those countries.

Postmetastasis survival in high‐grade extremity osteosarcoma: A retrospective analysis of prognostic factors in 126 patients

“…The overall survival rate of osteosarcoma has significantly improved after the introduction of combination chemotherapy and surgery; currently, about 70% of patients have a chance of cure . However, approximately 18% of patients are known to have metastasis at the time of diagnosis of osteosarcoma, and about 30% of patients experience metastasis even without metastasis at diagnosis . In contrast to the improved treatment outcomes for primary localized osteosarcoma, the treatment outcomes for metastatic osteosarcoma patients have not improved significantly over the past 30 years, and the 5‐year survival rate after metastasis is 17‐37% .…”

Parthenolide Induces Reactive Oxygen Species-Mediated Autophagic Cell Death in Human Osteosarcoma Cells

“…Osteosarcoma (OS) which usually occurred in children and adolescents is the most common primary malignant bone tumor [1][2][3]. Chemotherapy, such as cisplatin, doxorubicin and methotrexate is the preferred choice treatment for OS.…”

A comparison of risk factors for metastasis at diagnosis in humans and dogs with osteosarcoma

“…In the United States, race/ethnicity is highly correlated with socioeconomic status (SES), and previous analyses of SEER data has shown that counties with the lowest composite SES scores have a higher proportion of patients with metastasis at diagnosis . It is also the case that the prevalence of metastasis at diagnosis is higher in countries with lower human development index scores, where there are more barriers to accessing appropriate healthcare . Conversely, a recent mediation analysis of several pediatric cancers reported that SES could not fully account for the survival disparities across different racial groups, indicating that other factors, including intrinsic tumor biology, may also play a role .…”