Min Wook Joo1, Seung Han Shin2, Yong-Koo Kang1, Akira Kawai3, Han Soo Kim4, Apichat Asavamongkolkul5, Dae-Geun Jeon6, Jae Do Kim7, Xiaohui Niu8, Hiroyuki Tsuchiya9, Ajay Puri10, Edward H M Wang11, So Hak Chung7, Yang-Guk Chung12. 1. Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon-si, Gyeonggi-do, Republic of Korea. 2. Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 3. Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan. 4. Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea. 5. Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 6. Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea. 7. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea. 8. Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, China. 9. Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan. 10. Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India. 11. Tumor Service, Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines. 12. Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. ygchung@catholic.ac.kr.
Abstract
BACKGROUND: Elderly patients with osteosarcoma (OSA) are no longer uncommon; however, many questions remain regarding this population. We investigated the clinicopathological characteristics and prognostic factors of OSA in an Asian population over the age of 40 years. METHODS: This was a multi-national, multi-institutional study by the Eastern Asian Musculoskeletal Oncology Group (EAMOG). RESULTS: A total of 232 patients were enrolled (116 males and 116 females), with a median age of 50 years at diagnosis; 25 (10.8 %) patients exhibited initial metastasis. Median follow-up was 52 months for survivors. We observed 102 osteolytic and mixed radiographic findings for 173 lesions. Histological subtypes other than osteoblastic type were frequent. Radiation-associated OSA was seen in seven patients, with a 5-year overall survival (OS) of 16.7 %. No Paget's OSA was observed. High-grade spinopelvic OSA was seen in 29 (12.5 %) patients. The 5-year OS was 59.4 % in patients without initial metastasis and 45.2 % in patients with spinopelvic OSA. While surgery and initial metastasis were common prognostic factors for OS, chemotherapy was not. Histologic response to neoadjuvant chemotherapy was poor in 61 of 83 patients. CONCLUSION: This study revealed distinct clinicopathological features of OSA patients over 40 years of age compared with younger patients, such as the high incidence of axial tumors, common osteolytic and mixed radiographic findings, the high frequency of unusual histologic subtypes, and poor prognosis. Contrary to Western elderly patients with OSA, there was no Paget's OSA in this study, which may result in a lower incidence of secondary OSA. Prognostic factor analyses demonstrated chemotherapy did not influence OS.
BACKGROUND: Elderly patients with osteosarcoma (OSA) are no longer uncommon; however, many questions remain regarding this population. We investigated the clinicopathological characteristics and prognostic factors of OSA in an Asian population over the age of 40 years. METHODS: This was a multi-national, multi-institutional study by the Eastern Asian Musculoskeletal Oncology Group (EAMOG). RESULTS: A total of 232 patients were enrolled (116 males and 116 females), with a median age of 50 years at diagnosis; 25 (10.8 %) patients exhibited initial metastasis. Median follow-up was 52 months for survivors. We observed 102 osteolytic and mixed radiographic findings for 173 lesions. Histological subtypes other than osteoblastic type were frequent. Radiation-associated OSA was seen in seven patients, with a 5-year overall survival (OS) of 16.7 %. No Paget's OSA was observed. High-grade spinopelvic OSA was seen in 29 (12.5 %) patients. The 5-year OS was 59.4 % in patients without initial metastasis and 45.2 % in patients with spinopelvic OSA. While surgery and initial metastasis were common prognostic factors for OS, chemotherapy was not. Histologic response to neoadjuvant chemotherapy was poor in 61 of 83 patients. CONCLUSION: This study revealed distinct clinicopathological features of OSA patients over 40 years of age compared with younger patients, such as the high incidence of axial tumors, common osteolytic and mixed radiographic findings, the high frequency of unusual histologic subtypes, and poor prognosis. Contrary to Western elderly patients with OSA, there was no Paget's OSA in this study, which may result in a lower incidence of secondary OSA. Prognostic factor analyses demonstrated chemotherapy did not influence OS.
Authors: Min Wook Joo; Yong Koo Kang; Koichi Ogura; Shintaro Iwata; June Hyuk Kim; Won Ju Jeong; Xiaohui Niu; Pramod S Chinder; Han Soo Kim; Sung Wook Seo; Yang-Guk Chung Journal: PLoS One Date: 2018-10-17 Impact factor: 3.240