Lisa Marie Kelley1, Miriam Schlegel1, Stefanie Hecker-Nolting2, Matthias Kevric2, Bernhard Haller3, Claudia Rössig4, Peter Reichardt5, Leo Kager6, Thomas Kühne7, Georg Gosheger8, Reinhard Windhager9, Katja Specht10, Hans Rechl11, Per-Ulf Tunn12, Daniel Baumhoer13, Thomas Wirth14, Mathias Werner15, Thekla von Kalle16, Michaela Nathrath1,17, Stefan Burdach1, Stefan Bielack2, Irene von Lüttichau1. 1. Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, CCCM Munich Comprehensive Cancer Center and German Translational Cancer Research Consortium DKTK, Munich, Germany. 2. Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany. 3. Institute for Medical Informatics, Statistics, and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. 4. Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany. 5. Helios Klinikum Berlin-Buch, Klinik für Onkologie und Palliativmedizin, Berlin, Germany. 6. Department of Pediatrics, St Anna Children's Hospital, Medical University Vienna, Vienna, Austria. 7. Pediatric Oncology and Hematology, Universitäts-Kinderspital beider Basel, Basel, Switzerland. 8. Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany. 9. Allgemeines Krankenhaus der Stadt Wien, Universitätsklinik für Orthopädie der Medizinischen Universität Wien, Vienna, Austria. 10. Technische Universität München, Institut für Allgemeine Pathologie und Pathologische Anatomie, Munich, Germany. 11. Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Munich, Germany. 12. Helios Klinikum Berlin-Buch, Klinik für Tumororthopädie, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany. 13. Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland. 14. Klinik für Orthopädie, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany. 15. Vivantes Klinikum im Friedrichshein, Institut für Pathologie, Osteopathologie-Referenzzentrum, Berlin, Germany. 16. Radiological Institute, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany. 17. Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany.
Abstract
PURPOSE: The objective of this study was to investigate potential correlations between pathologic fractures (PFs) and prognosis of patients with primary central high-grade osteosarcoma of the extremities. METHODS: We retrospectively analyzed 2,847 patients registered in the Consecutive Cooperative Osteosarcoma Study Group database with primary central high-grade osteosarcoma of the extremities, treated between 1980 and 2010. Intended treatment included pre- and postoperative chemotherapy and surgery. Univariable and multivariable survival analyses were performed for all patients and then differentiated for adult and pediatric (≤ 18 years at time of diagnosis) patients. RESULTS: A total of 2,193 patients were ≤ 18 years of age; 11.3% of all patients had PFs. In the overall cohort, presence of PF correlated significantly with tumor site, histologic subtype, relative tumor size, and primary metastases, but not with body mass index or local surgical remission. In univariable analysis, 5-year overall survival (OAS) of patients with and without PF was 63% versus 71%, respectively (P = .007), and 5-year event-free survival (EFS) was 51% versus 58% (P = .026). In pediatric patients, OAS and EFS did not differ significantly between patients with and without PF. In adults, 5-year OAS in patients with and without PF was 46% versus 69% (P < .001), and 5-year EFS was 36% versus 56% (P < .001). In multivariable analysis, PF was not a statistically significant factor for OAS or EFS in the total cohort or in pediatric patients. In adult patients, PF remained an independent prognostic factor for OAS (P = .013; hazard ratio [HR], 1.893). It was not a significant prognostic factor for EFS (P = .263; HR, 1.312). CONCLUSION: In this largest study to date with extremity osteosarcomas, we observed the occurrence of PF to correlate with inferior OAS expectancies in adult but not in pediatric patients.
PURPOSE: The objective of this study was to investigate potential correlations between pathologic fractures (PFs) and prognosis of patients with primary central high-grade osteosarcoma of the extremities. METHODS: We retrospectively analyzed 2,847 patients registered in the Consecutive Cooperative Osteosarcoma Study Group database with primary central high-grade osteosarcoma of the extremities, treated between 1980 and 2010. Intended treatment included pre- and postoperative chemotherapy and surgery. Univariable and multivariable survival analyses were performed for all patients and then differentiated for adult and pediatric (≤ 18 years at time of diagnosis) patients. RESULTS: A total of 2,193 patients were ≤ 18 years of age; 11.3% of all patients had PFs. In the overall cohort, presence of PF correlated significantly with tumor site, histologic subtype, relative tumor size, and primary metastases, but not with body mass index or local surgical remission. In univariable analysis, 5-year overall survival (OAS) of patients with and without PF was 63% versus 71%, respectively (P = .007), and 5-year event-free survival (EFS) was 51% versus 58% (P = .026). In pediatric patients, OAS and EFS did not differ significantly between patients with and without PF. In adults, 5-year OAS in patients with and without PF was 46% versus 69% (P < .001), and 5-year EFS was 36% versus 56% (P < .001). In multivariable analysis, PF was not a statistically significant factor for OAS or EFS in the total cohort or in pediatric patients. In adult patients, PF remained an independent prognostic factor for OAS (P = .013; hazard ratio [HR], 1.893). It was not a significant prognostic factor for EFS (P = .263; HR, 1.312). CONCLUSION: In this largest study to date with extremity osteosarcomas, we observed the occurrence of PF to correlate with inferior OAS expectancies in adult but not in pediatric patients.