Wei Zhong1, Ziyi Wu1, Yuhao Yuan1, Wei Luo1,2. 1. Department of Orthopaedics, Xiangya Hospital, Central South University 87th Xiangya Road, Changsha, Hunan, P. R. China. 2. National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Changsha, Hunan, P. R. China.
Abstract
AIM: To evaluate the prognosis of surgical treatment of osteosarcoma complicated by pathologic fracture. MATERIALS AND METHODS: We searched articles in PubMed, Web of Science, and Embase for studies published up to January 1, 2022, that reported the surgical prognosis of osteosarcoma patients complicated with/without pathologic fracture. The specific outcome indicators used in the meta-analysis included the local recurrence rate (LRR), distant metastasis rate (DMR), overall survival (OS) rate and disease-free survival (DFS) rate after surgical treatment such as amputation or limb salvage in the pathologic fracture group and non-pathologic fracture group. Crude and adjusted Odds Ratio (OR) with 95% confidence intervals were used to compare data between the case group and control group. Fifteen studies and 3839 patients were included in the final meta-analysis. RESULTS: The difference between the pathologic fractures group and the non-pathologic fracture group was not statistically significance in LRR analysis (OR = 1.27, 95% CI: 0.88-1.84, P > 0.05); however, a statistically significant difference was found between two groups in DMR (OR = 1.42, 95% CI: 1.03-1.95, P < 0.05). For survival rates, the following ORs were found: 3-year OS (OR = 1.71, 95% CI: 1.25-2.35, P < 0.05); 5-year OS (OR = 1.41, 95% CI: 1.06-1.87, P < 0.05); 3-year DFS (OR = 1.88, 95% CI: 1.20-2.94, P < 0.05); and 5-year DFS (OR = 1.49, 95% CI: 1.10-2.03, P < 0.05). The pooled estimate of OR is 1.48 (95% CI: 0.72-3.04, P > 0.05) for local recurrence and 1.82 (95% CI: 0.92-3.60, P > 0.05) for distant metastasis in the amputation group and the limb salvage group for osteosarcoma patients with pathologic fractures, respectively. Our analysis indicated that patients with a pathologic fracture have a higher risk of DMR after surgery, but there is no significant difference in LRR between patients with a pathologic fracture and without. Additionally, in osteosarcoma patients with a pathologic fracture, there was no difference in LDR or DMR between limb-salvage surgery and amputation. CONCLUSION: Complicated with pathologic fracture is a negative prognostic indicator of osteosarcoma, and its poor survival rates (both OS and DFS) may be associated with a higher DMR. For osteosarcoma patients with pathologic fractures treated with standard treatment, LRR and DMR exhibit no significant difference between amputation and limb-salvage surgery. AJTR
AIM: To evaluate the prognosis of surgical treatment of osteosarcoma complicated by pathologic fracture. MATERIALS AND METHODS: We searched articles in PubMed, Web of Science, and Embase for studies published up to January 1, 2022, that reported the surgical prognosis of osteosarcoma patients complicated with/without pathologic fracture. The specific outcome indicators used in the meta-analysis included the local recurrence rate (LRR), distant metastasis rate (DMR), overall survival (OS) rate and disease-free survival (DFS) rate after surgical treatment such as amputation or limb salvage in the pathologic fracture group and non-pathologic fracture group. Crude and adjusted Odds Ratio (OR) with 95% confidence intervals were used to compare data between the case group and control group. Fifteen studies and 3839 patients were included in the final meta-analysis. RESULTS: The difference between the pathologic fractures group and the non-pathologic fracture group was not statistically significance in LRR analysis (OR = 1.27, 95% CI: 0.88-1.84, P > 0.05); however, a statistically significant difference was found between two groups in DMR (OR = 1.42, 95% CI: 1.03-1.95, P < 0.05). For survival rates, the following ORs were found: 3-year OS (OR = 1.71, 95% CI: 1.25-2.35, P < 0.05); 5-year OS (OR = 1.41, 95% CI: 1.06-1.87, P < 0.05); 3-year DFS (OR = 1.88, 95% CI: 1.20-2.94, P < 0.05); and 5-year DFS (OR = 1.49, 95% CI: 1.10-2.03, P < 0.05). The pooled estimate of OR is 1.48 (95% CI: 0.72-3.04, P > 0.05) for local recurrence and 1.82 (95% CI: 0.92-3.60, P > 0.05) for distant metastasis in the amputation group and the limb salvage group for osteosarcoma patients with pathologic fractures, respectively. Our analysis indicated that patients with a pathologic fracture have a higher risk of DMR after surgery, but there is no significant difference in LRR between patients with a pathologic fracture and without. Additionally, in osteosarcoma patients with a pathologic fracture, there was no difference in LDR or DMR between limb-salvage surgery and amputation. CONCLUSION: Complicated with pathologic fracture is a negative prognostic indicator of osteosarcoma, and its poor survival rates (both OS and DFS) may be associated with a higher DMR. For osteosarcoma patients with pathologic fractures treated with standard treatment, LRR and DMR exhibit no significant difference between amputation and limb-salvage surgery. AJTR
Authors: Wan Hyeong Cho; Won Seok Song; Dae-Geun Jeon; Chang-Bae Kong; Min Suk Kim; Jun Ah Lee; Ji Young Yoo; Jae Do Kim; Soo-Yong Lee Journal: Ann Surg Oncol Date: 2010-03 Impact factor: 5.344
Authors: Bao Pingping; Zhou Yuhong; Lu Weiqi; Wu Chunxiao; Wang Chunfang; Sun Yuanjue; Zhang Chenping; Xiao Jianru; Lu Jiade; Kong Lin; Cai Zhengdong; Zhang Weibin; Fu Chen; Yao Yang Journal: Front Oncol Date: 2019-07-17 Impact factor: 6.244