Survival and prognostic factors in chondrosarcoma

Abstract

Background and purpose There have been few long-term studies on the outcome of chondrosarcoma and the findings regarding prognostic factors are controversial. We examined a homogeneous group of patients with primary central chondrosarcoma of bone who were treated according to a uniform surgical protocol at our institution, in order to determine the factors that influence survival and identify potential improvements to our therapeutic algorithm.Patients and methods We performed a retrospective analysis of 115 patients with primary central chondrosarcoma of bone who presented with localized disease and who had a minimum follow-up of 5 years after diagnosis. 68 tumors were localized in the extremities and 47 in the axial skeleton or pelvis. 59 patients had a high-grade (II and III) and 56 a low-grade (I) tumor. 94 patients underwent surgical resection with adequate (wide or radical) margins, while 21 patients had inadequate (marginal or intralesional) margins.Results Tumor grade and localization were found to be statistically significant independent predictors of disease-related deaths in multivariate analysis. The quality of surgical margins did not influence survival. The AJCC staging system was able to predict prognosis in patients with chondrosarcoma of the extremities, but not in those with tumors of the axial skeleton and pelvis. Long-term survival after secondary metastatic disease was only observed when metastases were resected with wide margins. Patients with metastases who received further treatment with conventional chemotherapy, radiotherapy, and/or further surgery had significantly better survival compared to those who received best supportive care.Interpretation The outcome in patients with primary central chondrosarcoma of bone who present with localized disease is mostly affected by tumor-related parameters.

Survival and prognostic factors in conventional central chondrosarcoma

“…This is about the same as described by other authors [10, 34–36]. There are series with a lesser [37, 38] or a higher [16, 39] proportion of metastatic disease.…”

“…There are patients, in whom metastatic disease is manageable by resection, local radiation or systemic therapy, leading to survival rates of 10–30% after 10 years, as also in this study. But this is the exception, mainly seen in G1 tumors [9, 34, 40]. Our results show, that MD is more common in G2/3 lesions as described by others [9, 34, 39, 41] but it is independent from surgical margins with the same rate of MD in R0 and R1 resected patients, and also independent from LR.…”

Chondrosarcoma of the Temporomandibular Disc: Behavior Over a 28-Year Observation Period

“…35 Heck et al 36 noted that ''.grading of bone tumors is somewhat subjective, based on degree of cellularity and extent of metaplasia.,'' grading is used to differentiate AJCC TNM staging, and the latter is not correlated with clinical outcomes, at least with axial skeletal lesions. 36,37 It is uncertain as to whether the current AJCC classification assists in prognosis or whether the MSTS's emphasis on surgical elements or inclusion of vital markers will lead to a new staging system for this lesion. 37 By any reckoning, chondrosarcoma of the head and neck is uncommon.…”

“…36,37 It is uncertain as to whether the current AJCC classification assists in prognosis or whether the MSTS's emphasis on surgical elements or inclusion of vital markers will lead to a new staging system for this lesion. 37 By any reckoning, chondrosarcoma of the head and neck is uncommon. Most surveys have reported more frequent occurrence in the midface structures than in the mandible, 2,30,38,39 but the mandible has shown precedence in some reports.…”

Osteosarkomatös dedifferenziertes Chondrosarkom

“…Da es sich bei den publizierten Daten meist um Fallberichte handelt, werden prognostisch relevante Aussagen weitgehend vermisst [6]. Die R0-Resektion hat nach heutigem Wissensstand den wichtigsten prognostischen Stellenwert [2,3,8,11,14]. …”