Primary osteosarcoma in adults older than 40 years.

The aim of the current study was to determine the prognostic factors of primary osteosarcoma in adults. This is a review of 47 patients older than 40 years (27 men and 20 women) who were treated between 1977 and 1998 at the authors' institution. Tumors involved the lower limbs in 26 patients and the axial skeleton in 18 patients (38.3%). Eight patients (17%) had synchronous pulmonary metastasis and seven had a pathologic fracture before the definitive surgery. At review, 33 patients had died and 13 were alive. Twenty-one patients (44.7%) did not receive any form of systemic treatment. Tumors were treated surgically in 42 patients (89%). Local recurrence was documented in seven patients (17%). Metastasis after diagnosis appeared in 29 patients (61.7%). The 5-year disease-free survival and overall survival rates were 32.54% and 41.64%, respectively. Adult patients (> 19 years) with primary osteosarcoma had a poor clinical outcome. Metastatic disease at presentation or later, a pathologic fracture, large tumor volumes, and inadequate margins at the time of surgery were associated with significantly lower survival. The high number of adults presenting with advanced stage lesions and more tumors in the axial location might explain the high rate of recurrences. Aggressive multiagent regimens are needed to improve survival.