Prognostic Factors in High-Grade Osteosarcoma of the Extremities or Trunk: An Analysis of 1,702 Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

American Society of Clinical Oncology (ASCO) - Tập 20 Số 3 - Trang 776-790 - 2002
Stefan Bielack1, Beate Kempf‐Bielack1, G. Delling1, G. Ulrich Exner1, Silke Flege1, K. Helmke1, R. Kotz1, M. Salzer‐Kuntschik1, Matthias Werner1, Winfried Winkelmann1, A. Zoubek1, Heribert Jürgens1, Kurt Winkler1
1From the Klinik und Poliklinik für Kinderheilkunde, Pädiatrische Hämatologie/Onkologie, and Klinik und Poliklinik für Allgemeine Orthopädie, Universitätsklinikum, Münster; Abteilung für Osteopathologie, Abteilung fur Pädiatrische Radiologie, and Abteilung für Pädiatrische Hämatologie und Onkologie, Universitäts-Krankenhaus Eppendorf, Hamburg, Germany; Universitätsklinik für Orthopädie, Wiener Knochengeschwulstregister, and St Anna Kinderspital, Vienna, Austria; and Orthopädische Universitätsklinik...

Tóm tắt

PURPOSE: To define prognostic factors for response and long-term outcome for a wide spectrum of osteosarcomas, extending well beyond those of the typical young patient with seemingly localized extremity disease. PATIENTS AND METHODS: A total of 1,702 consecutive newly diagnosed patients with high-grade osteosarcoma of the trunk or limbs registered into the neoadjuvant studies of the Cooperative Osteosarcoma Study Group before July 1998 were entered into an analysis of demographic, tumor-related, and treatment-related variables, response, and survival. The intended therapeutic strategy included preoperative and postoperative chemotherapy with multiple agents as well as surgery of all operable lesions. RESULTS: Axial tumor site, male sex, and a long history of symptoms were associated with poor response to chemotherapy in univariate and multivariate analysis. Actuarial 10-year overall and event-free survival rates were 59.8% and 48.9%. Among the variables assessable at diagnosis, patient age (actuarial 10-year survival ≥ 40, 41.6%; < 40, 60.2%; P = .012), tumor site (axial, 29.2%; limb, 61.7%; P < .0001), and primary metastases (yes, 26.7%; no, 64.4%; P < .0001), and for extremity osteosarcomas, also size (≥ one third, 52.5%; < one third, 66.7%; P < .0001) and location within the limb (proximal, 49.3%; other, 63.9%; P < .0001), had significant influence on outcome. Two additional important prognostic factors were treatment related: response to chemotherapy (poor, 47.2%; good, 73.4%; P < .0001) and the extent of surgery (incomplete, 14.6%; macroscopically complete, 64.8%; P < .0001). All factors except age maintained their significance in multivariate testing, with surgical remission and histologic response emerging as the key prognostic factors. CONCLUSION: Tumor site and size, primary metastases, response to chemotherapy, and surgical remission are of independent prognostic value in osteosarcoma.

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American Society of Clinical Oncology (ASCO)

Tập 20 Số 3

776-790

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