Prognostic Factors and Treatment Results of High-Grade Osteosarcoma in Norway: A Scope Beyond the “Classical” Patient

Abstract

Purpose. A retrospective study of prognostic factors and treatment outcome of osteosarcoma (OS) during modern chemotherapy era with focus on patients with primary metastatic disease, nonextremity localisation, or age >40 years (nonclassical OS). Methods. A nationwide cohort, comprising 424 high-grade Norwegian bone OS patients, was based on registry sources supplemented with clinical records from hospitals involved in sarcoma management between 1975 and 2009. Results. Only 48% were younger patients with tumour in the extremities and without metastasis at diagnosis (classical OS). A considerable discrepancy in survival between classical and nonclassical OS was observed: 61% versus 26% 10-year sarcoma specific survival. Twice as many of the former received both adequate surgery and chemotherapy compared to the latter. This could only partly explain the differences in survival due to inherent chemoresistance in primary metastatic disease and a higher rate of local relapse among patients with axial tumours. Metastasis at diagnosis, increased lactate dehydrogenase, age > 40 years, and tumour size above median value were all adverse prognostic factors for overall survival. Conclusion. We confirm a dramatic difference in outcome between classical and nonclassical high-grade OS patients, but treatment variables could only partly explain the dismal outcome of the latter.

Delay in Diagnosis and Its Effect on Clinical Outcome in High‐grade Sarcoma of Bone: A Referral Oncological Centre Study

“…Tumor location and resectability, metastatic disease at diagnosis, response to chemotherapy and local recurrence are known prognostic factors for osteosarcoma and Ewing sarcoma according to published reports 8,26,[28][29][30][31][32][33][34] .…”

Prognostic Impact of Proximal Versus Distal Localization in Extremity Long Bone Osteosarcomas

“…Adequate surgery implied surgical removal of the primary tumor with wide or marginal margins as described by Enneking et al (13), while adequate chemotherapy was defined as having received at least six courses of chemotherapy. The latter definition with its justification, is more thoroughly presented in a previous study (5). Patients with metastatic disease at the time of diagnosis were in need for a surgical remission for both primary tumor and metastases in order to be classified as having undergone adequate surgical treatment.…”

“…It is well established that axial tumor locations of osteosarcoma (OS) result in a worse outcome than primary disease located in the appendicular skeleton (1)(2)(3)(4)(5). Proximal osteosarcoma in extremity long bones (POS) has also been associated with poor outcome (4,(6)(7)(8), although the prognostic impact of the anatomical location of such tumors is still debated (6,8,9).…”

The associations of vascular endothelial growth factor gene polymorphisms with susceptibility to osteosarcoma: evidence from a meta-analysis

“…), the prognosis for confirmed cases is depressing, especially for those in advanced stage (Pediatric Treatment Editorial Board ; Berner et al . ). Several prognostic factors comprised of primary tumour site (Goldstein‐Jackson et al .…”

“…Contrary to the young population, osteosarcoma occurs in the aged patients more commonly in axial skeletons rather than long tubular bones, especially in areas that have been previously irradiated or have bone abnormalities (Hayden & Hoang 2006). Although the prevalence rate is relatively low when compared with other tumour types (Ottaviani & Jaffe 2009;Hung et al 2014), the prognosis for confirmed cases is depressing, especially for those in advanced stage (Pediatric Treatment Editorial Board 2002;Berner et al 2015). Several prognostic factors comprised of primary tumour site (Goldstein-Jackson et al 2005), tumour size (Pakos et al 2009), and clinically detectable metastasis (Pediatric Treatment Editorial Board 2002) have been identified to be significantly associated with the 5-year survival rate.…”