Prognostic factors in osteosarcomas. A regression analysis

Abstract

A multivariate regression analysis of survival data, using the Cox proportional hazards model (PHM), was performed on the retrospective material of 184 osteosarcoma patients treated at the Aarhus and Copenhagen oncology centers, Denmark, from 1963 to 1984. All patients were previously untreated. Radical surgery, in general ablative when possible, was the primary treatment goal throughout this period. A number of clinical and pathologic variables were tested in the model to elucidate their prognostic importance. Tumors localized to the trunk, pelvis, or femur, and symptom duration of less than 6 months were poor prognostic signs. Tumors dominated by fibroblastic cells and a patient age of approximately 25 to 30 years were associated with an especially good prognosis. The prognosis worsened with advancing age. Children, adolescents, and adults ages 5 to 25 years had significantly poorer prognosis than young adults 25 to 30 years of age. Sex, radiologic appearance, and year of referral had no significant prognostic value in this series. Based on the regression model, a prognostic index is derived and survival is calculated for a good and a poor prognostic case. The overall 10-year survival with one standard deviation was 28.6 +/- 3.5%. Cancer deaths continue to occur 10 years after initial treatment, and the estimated hazard rate is still four times greater than that of a sex- and age-matched group of healthy individuals.

Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma

“…Consistent with prior reports, tumor size, 7,14,31,32 anatomic site, 7,13,15,32 and metastatic status at presentation 7,10,31,33,34 were strong determinants of survival outcome. After adjusting for these parameters, tumor subtype retained independent prognostic significance.…”

“…The prognostic significance of chondroblastic differentiation has been controversial, with conflicting reports of association with better 12 as well as worse 5,33 survival, whereas fibroblastic tumors have been associated with better prognosis compared with osteoblastic and chondroblastic subtypes. 13 Such discrepancies may be partially explained by differences in diagnostic criteria employed in previous studies. According to Dahlin and Unni's classification, 34 subsequently expanded by the World Health Organization, the subclassification of conventional osteosarcomas is based on the predominant line of differentiation.…”

“…Although a number of groups have assessed the contribution of clinical parameters-namely, patient age, sex, anatomic site of primary tumor, tumor size, and metastasis at presentation-in predicting survival outcomes for patients with osteosarcoma, [5][6][7][8][9] there are limited data concerning histopathologic attributes. The role of tumor pleomorphism, 10 mitotic activity, 11 and morphologic subtype 6,10,[12][13][14] as prognostic factors appears to be limited. Moreover, it is unclear whether these features should be assessed on treatment-naive biopsy specimens or on resection following neoadjuvant chemotherapy.…”

A regression analysis of prognostic factors after resection of Dukes' B and C carcinoma of the rectum and rectosigmoid. Does post-operative radiotherapy change the prognosis?

“…The proportional hazards assumption was tested graphically. A more detailed description of the procedure has been given recently (Bentzen et al, 1988).…”

Intraarterial Chemotherapy for Extremity Osteosarcoma and MFH in Adults

“…Malignant fibrous histiocytoma (MFH) of bone is more common in adults than children and responds to the same treatment as OGS [39]. The treatment regimens and survival rates for these bone sarcomas have improved over the last decade; however, some reports suggest a worse prognosis in patients younger than 10 years and older than 30 [8,12,36,39].…”