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Teng JS, Wang Y. An immune-related eleven-RNA signature-drived risk score model for prognosis of osteosarcoma metastasis. Sci Rep 2024; 14:13401. [PMID: 38862526 PMCID: PMC11166963 DOI: 10.1038/s41598-024-54292-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/10/2024] [Indexed: 06/13/2024] Open
Abstract
This study aimed to determine an immune-related RNA signature as a prognostic marker, in this study, we developed a risk score model for predicting the prognosis of osteosarcoma metastasis. We first downloaded the clinical information and expression data of osteosarcoma samples from the UCSC Xena and GEO databases, of which the former was the training set and the latter was the validation set. Immune infiltration was assessed using the ssGSEA and ESTIMATE algorithms, and the osteosarcoma samples were divided into the Immunity_L and Immunity_H groups. Then, eleven RNAs were identified as the optimal prognostic RNA signatures using LASSO Cox regression analysis for establishing a risk score (RS) model. Kaplan-Meier approach indicated the high-risk group exhibited a shorter survival. Furthermore, we analyzed the tumor metastasis, age, and RS model status were determined to be independent clinical prognostic factors using Cox regression analysis. Decision curve analysis (DCA) indicated that the prognostic factor + RS model had the best net benefit. Finally, nine tumor-infiltrating immune cells (TIICs) showed significant differences in abundance between high- and low-risk groups via CIBERSORT deconvolution algorithm. In conclusion, the immune-related eleven-RNA signature be could served as a potential prognostic biomarker for osteosarcoma metastasis.
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Affiliation(s)
- Jia-Song Teng
- The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No. 23 Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu, China
| | - Yang Wang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, No. 126 Xiantai Street, Changchun, 130033, Jilin, China.
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Yin C, Chokkakula S, Li J, Li W, Yang W, Chong S, Zhou W, Wu H, Wang C. Unveiling research trends in the prognosis of osteosarcoma: A bibliometric analysis from 2000 to 2022. Heliyon 2024; 10:e27566. [PMID: 38515706 PMCID: PMC10955242 DOI: 10.1016/j.heliyon.2024.e27566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Background Osteosarcoma (OSA) is the most prevalent form of malignant bone tumor in children and adolescents, producing osteoid and immature bone. Numerous high quality studies have been published in the OSA field, however, no bibliometric study related to this area has been reported thus far. Therefore, the present study retrieved the published data from 2000 to 2022 to reveal the dynamics, development trends, hotspots and future directions of the OSA. Methods Publications regard to osteogenic sarcoma and prognosis were searched in the core collection on Web of Science database. The retrieved publications were analyzed by publication years, journals, categories, countries, citations, institutions, authors, keywords and clusters using the two widely available bibliometric visualization tools, VOS viewer (Version 1.6.16), Citespace (Version 6.2. R1). Results A total of 6260 publications related to the current topic were retrieved and analyzed, revealing exponential increase in the number of publications with an improvement in the citations on the OSA over time, in which China and the USA are the most productive nations. Shanghai Jiao Tong University, University of Texas System and Harvard University are prolific institutions, having highest collaboration network. Oncology Letters and Journal of Clinical Oncology are the most productive and the most cited journals respectively. The Wang Y is a prominent author and articles published by Bacci G had the highest number of citations indicating their significant impact in the field. According to keywords analysis, osteosarcoma, expression and metastasis were the most apparent keywords whereas the current research hotspots are biomarker, tumor microenvironment, immunotherapy and DNA methylation. Conclusion Our findings offer valuable information for researchers to understand the current research status and the necessity of future research to mitigate the mortality of the OS patients.
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Affiliation(s)
- Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Santosh Chokkakula
- Department of Microbiology, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Chungbuk, South Korea
| | - Jie Li
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wenle Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Weiguang Yang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Siomui Chong
- Department of Dermatology, The First Affiliated Hospital of Jinan University and Jinan University Institute of Dermatology, Guangzhou, China
- Institute of Collaborative Innovation, University of Macau, Macau, China
- Centro Medico Kong Wan (Macau), Macao, China
| | - Wenzheng Zhou
- Department of Orthopaedics, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Haiyang Wu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Chengbin Wang
- Department of Laboratory Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Kim C, Davis LE, Albert CM, Samuels B, Roberts JL, Wagner MJ. Osteosarcoma in Pediatric and Adult Populations: Are Adults Just Big Kids? Cancers (Basel) 2023; 15:5044. [PMID: 37894411 PMCID: PMC10604996 DOI: 10.3390/cancers15205044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Malignant bone tumors are commonly classified as pediatric or adolescent malignancies, and clinical trials for these diseases have generally focused on these populations. Of primary bone cancers, osteosarcoma is among the most common. Osteosarcoma has a bimodal age distribution, with the first peak occurring in patients from 10 to 14 years old, and the second peak occurring in patients older than 65, with about 25% of cases occurring in adults between 20 and 59 years old. Notably, adult osteosarcoma patients have worse outcomes than their pediatric counterparts. It remains unclear whether age itself is a poor prognostic factor, or if inherent differences in tumor biology exist between age groups. Despite these unknowns, current treatment strategies for adults are largely extrapolated from pediatric studies since the majority of clinical trials for osteosarcoma treatments are based on younger patient populations. In light of the different prognoses observed in pediatric and adult osteosarcoma, we summarize the current understanding of the molecular etiology of osteosarcoma and how it may differ between age groups, hypothesizing why adult patients have worse outcomes compared to children.
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Affiliation(s)
- Caleb Kim
- Division of Hematology and Oncology, University of Washington, Spokane, WA 99202, USA;
| | - Lara E. Davis
- Division of Hematology/Medical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Catherine M. Albert
- Division of Pediatric Hematology, Oncology, Bone Marrow Transplant and Cellular Therapy, Seattle Children’s Hospital, Seattle, WA 98105, USA
| | | | - Jesse L. Roberts
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA 98109, USA
| | - Michael J. Wagner
- Division of Hematology and Oncology, University of Washington, Seattle, WA 98109, USA
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA
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Karczewski D, Gonzalez MR, Bedi A, Ready JE, Anderson ME, Lozano-Calderon SA. Giant cell-rich osteosarcoma: A match pair analysis of 11 new cases and literature review of 56 patients. J Surg Oncol 2023; 128:877-890. [PMID: 37292033 DOI: 10.1002/jso.27368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Limited remains known on giant cell-rich osteosarcoma (GCRO) with current studies being case reports or smaller series. This investigation compared GCRO and conventional osteoblastic osteosarcoma (OOS) with regard to demographics and survival. METHODS An institutional tumor registry was used to identify 11 patients (six males) treated for GCRO. Mean age was 43 years. Staging showed American Joint Committee on Cancer (AJCC) stages IIA in four and IIB in seven patients. Mean follow-up was 14 years. Study initiatives were: (1) Comparison of demographics between GCRO and 167 OOS from our institutional registry, (2) Differences in survival between GCRO and 33 OOS case controls (based on sex and AJCC stage), as well as 10 OOS using an age-based propensity match, and (3) Summary of all GCRO cases reported in the literature. RESULTS (1) Sex (p = 0.53), grading (p = 0.56), AJCC stage (p = 0.42), and chemotherapeutic response rate (p = 0.67) did not differ between groups. Age was significantly increased in GCRO (p = 0.001). (2) Case-control and propensity-matched groups revealed no difference in disease-free survival, local recurrence, and distant disease-free survival at 2 years (p > 0.05). (3) Mean age of 56 patients (50% males) reported in the literature was 26 years. After merging with our 11 cases, the 2-year disease-free survival was 66%. CONCLUSIONS GCRO remains a rare disease with high short-term mortality. Although affecting older patients more than conventional osteosarcoma, GCRO should not be viewed as a predictor of survival compared to OOS.
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Affiliation(s)
- Daniel Karczewski
- Department of Orthopedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcos R Gonzalez
- Department of Orthopedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Angad Bedi
- Department of Orthopedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John E Ready
- Department of Orthopedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Brigham Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan E Anderson
- Department of Orthopedic Surgery, Musculoskeletal Oncology Service, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderon
- Department of Orthopedic Surgery, Musculoskeletal Oncology Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Zhao Y, Gao J, Fan Y, Xu H, Wang Y, Yao P. A risk score model based on endoplasmic reticulum stress related genes for predicting prognostic value of osteosarcoma. BMC Musculoskelet Disord 2023; 24:519. [PMID: 37353812 DOI: 10.1186/s12891-023-06629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/12/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND We aimed to establish an osteosarcoma prognosis prediction model based on a signature of endoplasmic reticulum stress-related genes. METHODS Differentially expressed genes (DEGs) between osteosarcoma with and without metastasis from The Cancer Genome Atlas (TCGA) database were mapped to ERS genes retrieved from Gene Set Enrichment Analysis to select endoplasmic reticulum stress-related DEGs. Subsequently, we constructed a risk score model based on survival-related endoplasmic reticulum stress DEGs and a nomogram of independent survival prognostic factors. Based on the median risk score, we stratified the samples into high- and low-risk groups. The ability of the model was assessed by Kaplan-Meier, receiver operating characteristic curve, and functional analyses. Additionally, the expression of the identified prognostic endoplasmic reticulum stress-related DEGs was verified using real-time quantitative PCR (RT-qPCR). RESULTS In total, 41 endoplasmic reticulum stress-related DEGs were identified in patients with osteosarcoma with metastasis. A risk score model consisting of six prognostic endoplasmic reticulum stress-related DEGs (ATP2A3, ERMP1, FBXO6, ITPR1, NFE2L2, and USP13) was established, and the Kaplan-Meier and receiver operating characteristic curves validated their performance in the training and validation datasets. Age, tumor metastasis, and the risk score model were demonstrated to be independent prognostic clinical factors for osteosarcoma and were used to establish a nomogram survival model. The nomogram model showed similar performance of one, three, and five year-survival rate to the actual survival rates. Nine immune cell types in the high-risk group were found to be significantly different from those in the low-risk group. These survival-related genes were significantly enriched in nine Kyoto Encyclopedia of Genes and Genomes pathways, including cell adhesion molecule cascades, and chemokine signaling pathways. Further, RT-qPCR results demonstrated that the consistency rate of bioinformatics analysis was approximately 83.33%, suggesting the relatively high reliability of the bioinformatics analysis. CONCLUSION We established an osteosarcoma prediction model based on six prognostic endoplasmic reticulum stress-related DEGs that could be helpful in directing personalized treatment.
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Affiliation(s)
- Yong Zhao
- Department of Orthopaedic Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing, 312400, Zhejiang, China.
| | - Jijian Gao
- Department of Orthopaedic Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing, 312400, Zhejiang, China
| | - Yong Fan
- Department of Orthopaedic Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing, 312400, Zhejiang, China
| | - Hongyu Xu
- Department of Orthopaedic Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing, 312400, Zhejiang, China
| | - Yun Wang
- Department of Orthopaedic Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing, 312400, Zhejiang, China
| | - Pengjie Yao
- Department of Orthopaedic Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch), Shaoxing, 312400, Zhejiang, China
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Kang SH, Kim W, Lee JS, Suh JK, Kim H, Kim DK, Choi SH, Cho HW, Ju HY, Yoo KH, Sung KW, Koo HH, Seo SW, Im HJ, Lee JW, Koh KN. High-dose chemotherapy followed by autologous stem cell transplantation in pediatric patients with relapsed osteosarcoma. Pediatr Blood Cancer 2023; 70:e30233. [PMID: 36751119 DOI: 10.1002/pbc.30233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Patients with relapsed osteosarcoma have poor treatment outcomes. High-dose chemotherapy with autologous stem cell transplantation (HDCT/ASCT) has been used in several high-risk malignant solid tumors; however, few studies have evaluated their role in treating osteosarcoma. We evaluated the effectiveness of HDCT/ASCT in relapsed pediatric osteosarcoma cases. PROCEDURE We retrospectively reviewed the medical records of 40 patients diagnosed with and treated for relapsed osteosarcoma at Asan Medical Center and Samsung Medical Center from January 1996 to July 2019. RESULTS The median age of this cohort was 13.4 years (range: 6.1-18.2). The cohort's 5-year overall survival (OS) was 51.0% ± 0.1% during a median follow-up period of 67.5 months. Twenty-five patients (62.5%) achieved complete remission (CR) with salvage treatment, and the 5-year OS was 82.4% ± 0.1%, whereas none of the remaining 15 patients who did not achieve CR survived (p < .0001). Of the 25 CR cases, 15 underwent subsequent HDCT/ASCT. We compared the effect of HDCT/ASCT among patients who achieved CR. There were no significant differences in the 5-year OS outcomes between patients who did and did not receive HDCT/ASCT (83.9% ± 0.1%, 13/15 vs. 80.0% ± 0.1%, 8/10, respectively; p = .923). CONCLUSION To our knowledge, we report the first comparative cohort study that proved HDCT/ASCT does not significantly improve survival outcomes in relapsed osteosarcoma. Achievement of CR remains the most crucial factor for good survival outcomes.
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Affiliation(s)
- Sung Han Kang
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Wanlim Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Seok Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Kyung Suh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se Hoon Choi
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Won Cho
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Hee Young Ju
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Keon Hee Yoo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Ki Woong Sung
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Hong Hoe Koo
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Sung Wook Seo
- Department of Orthopedic Surgery, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Won Lee
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Samsung Medical Center, University of Sungkyunkwan School of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Richardson SM, Wurtz LD, Collier CD. Ninety Percent or Greater Tumor Necrosis Is Associated With Survival and Social Determinants of Health in Patients With Osteosarcoma in the National Cancer Database. Clin Orthop Relat Res 2023; 481:512-522. [PMID: 36099400 PMCID: PMC9928876 DOI: 10.1097/corr.0000000000002380] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 08/04/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The histologic response of osteosarcoma to chemotherapy is commonly cited as a prognostic factor and typically graded as the percent necrosis of the tumor at the time of surgical resection. Few studies, to our knowledge, have examined the relationship of tumor necrosis relative to other factors. Existing studies are limited by prolonged enrollment periods or analysis of patient subsets without the strongest predictor of mortality: metastasis at diagnosis. Additionally, the definitive threshold value for a good histologic response is commonly set at more than 90% tumor necrosis with little evidence; some authors advocate other values. QUESTION/PURPOSES (1) Are there alternative cutoff values for a good response to chemotherapy in a large, national cohort of contemporarily treated patients with osteosarcoma? (2) How does the association of histologic response to survival in osteosarcoma compare with other clinicopathologic factors? (3) What patient and clinical factors are associated with the histologic response? METHODS We identified 2006 patients with osteosarcoma diagnosed between 2010 and 2015 in the National Cancer Database (NCDB), a registry that includes 70% of all new cancers diagnosed in the United States with 90% follow-up. Patients were excluded for missing documentation of percent tumor necrosis (21% [425 of 2006]) or if definitive resection was not performed (< 1% [1 of 2006]). A total of 1580 patients were included in the analysis, with a mean follow-up duration of 37 ± 22 months. A Kaplan-Meier survival analysis, stratified by the percent tumor necrosis after chemotherapy, was performed for the 5-year period. Other covariates examined were sex, race, socioeconomic score composite, insurance type, Charlson/Deyo score, distance from the hospital, and location (metropolitan, urban, or rural). Clinical and sociodemographic data including patient-identified race from the patient's medical record is input into the NCDB by certified registrars. The NCDB only allows coding of one primary race for each patient; thus, most of our patients were grouped as White or Black race and the remaining were grouped as Other for our analysis. A multiple Cox regression analysis was performed to evaluate the effect of percent necrosis compared with other demographic, clinicopathologic, and treatment effects on survival. Finally, a multiple logistic regression analysis was performed to assess demographic and clinicopathologic characteristics associated with percent necrosis. RESULTS Five-year overall survival for patients with histologic gradings of 90% to 94% necrosis (70% [95% confidence interval (CI) 60.6% to 79.7%) and 95% to 100% necrosis (74% [95% CI 68% to 80.3%) was not different between groups (p = 0.47). A comparison of histologic responses below 90% necrosis found no difference in survival between patients with decreasing histologic response (p > 0.05). Necrosis of less than 90% was associated with worse survival (HR 2.00 [95% CI 1.58 to 2.52]; p < 0.001 compared with more than 90% necrosis), and factors most associated with poor survival were metastasis (HR 2.85 [95% CI 2.27 to 3.59]; p < 0.001) and skip metastasis at the time of diagnosis (HR 2.52 [95% CI 1.64 to 3.88]; p < 0.001). On multivariate analysis, adjusting for demographic, clinicopathologic, and treatment factors, social determinants of health were negatively associated with percent necrosis of 90% or more, including uninsured status (OR 0.46 [95% CI 0.23 to 0.92]; p = 0.02 compared with private insurance) and lower socioeconomic status composite (OR for the lowest first and second quartiles were 0.63 [95% CI 0.44 to 0.90]; p = 0.01 and 0.70 [95% CI 0.50 to 0.96]; p = 0.03, respectively). Race other than White or Black (OR 0.61 [95% CI 0.40 to 0.94]; p = 0.02 compared with White race) was also negatively associated with percent necrosis of more than 90% after controlling for available covariates. CONCLUSION This study suggests that a cutoff of 90% necrosis provides the best prognostic value for patients with osteosarcoma undergoing chemotherapy. Other threshold values did not show different survival benefits. Sociodemographic factors were associated with histologic response less than 90%. These associations must be carefully understood not as cause and effect but likely demonstrating the effects of health disparities and access to care. Although we controlled for multiple variables in our analysis, broad variables such as race may have been associated with histologic response due to unaccounted confounders. Medical providers should be aware of these associations to ensure equitable access and delivery of care because access to care may be responsible for these associations. Future studies should examine potential drivers of this observation, such as a delay in presentation or deviation from standard of care practices. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Spencer M. Richardson
- Department of Orthopaedic Surgery, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - L. Daniel Wurtz
- Department of Orthopaedic Surgery, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher D. Collier
- Department of Orthopaedic Surgery, Indiana University Health, Indiana University School of Medicine, Indianapolis, IN, USA
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Yang Y, Zhou C, Ma X. Use of Nomogram on Nutritional Assessment Indicators to Predict Clinical Outcomes in Patients Undergoing Surgical Resection for High-Grade Osteosarcoma. Nutr Cancer 2022; 74:3564-3573. [PMID: 35645226 DOI: 10.1080/01635581.2022.2081342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Yuhan Yang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Chen Zhou
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xuelei Ma
- Department of Biotherapy and Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Characteristics, Management, and Outcomes of Patients With Osteosarcoma: An Analysis of Outcomes From the National Cancer Database. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202202000-00013. [PMID: 35192571 PMCID: PMC8865506 DOI: 10.5435/jaaosglobal-d-22-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/18/2022]
Abstract
Introduction: Previous studies about osteosarcoma patient characteristics, management, and outcomes have limited patient numbers, combine varied tumor types, and/or are older studies. Methods: Patients with osteosarcoma from the 2004 to 2015 National Cancer Database data sets were separated into axial, appendicular, and other. Demographic and treatment data as well as 1-, 5-, and 10-year survival were determined for each group. A multivariate Cox analysis of patient variables with the likelihood of death was performed, and the Kaplan Meier survival curves were generated. Results: Four thousand four hundred thirty patients with osteosarcoma (3,435 appendicular, 810 axial, and 185 other) showed survival at 1-year, 5-year, and 10-year and was highest among the appendicular cohort (91.17%, 64.43%, and 58.58%, respectively). No change in survival was seen over the periods studied. The likelihood of death was greater with increasing age category, distant metastases, and treatment with radiation alone but less with appendicular primary site, treatment with surgery alone, or surgery plus chemotherapy. Discussion: Despite advances in tumor management, surgical excision remains the best predictor of survival for osteosarcomas. No difference was observed in patient survival from 2004 to 2015 and, as would be expected, distant metastases were a poor prognostic sign, as was increasing age, male sex, and axial location.
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Vangala N, Uppin SG, Rao KN, Chandrasekhar P, Gundeti S. Prognostic Significance of Clinical and Post-Neoadjuvant Chemotherapy Associated Histomorphological Parameters in Osteosarcoma: A Retrospective Study from a Tertiary Care Center. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1740113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Osteosarcoma is the most prevalent bone cancer in adolescents. Neoadjuvant chemotherapy (NACT) followed by resection is the current modality of treatment for osteosarcoma. Histological evaluation of extent of tumor necrosis on resection is a well-established prognostic indicator in osteosarcoma correlating with survival in most cases.
Objectives The main objective of this study was to establish prognostic significance of various clinical and histological parameters post-NACT in osteosarcoma and to compare the integrated prognostic index proposed by Chui et al, with grading of response to NACT by Huvos and Rosen for osteosarcoma.
Materials and Methods This is a retrospective study done over a period of four years and includes 47 cases of osteosarcoma treated with NACT. All slides were reviewed and association of various clinical and histological parameters with overall survival was assessed with chi-squared test and Cox-regression analysis.
Results Statistical analysis revealed the prognostic significance of age at presentation, anatomic site, primary tumor size, metastatic status, and clinical stage. Histological parameters such as mitosis ≥10/10hpfs, ≥10% residual tumor were significantly associated with poor survival. Tumor necrosis ≥ 90% (excluding areas of hemorrhage, fibrosis and acellular osteoid) was significantly associated with increased survival. An integrated prognostic index formed by combining above parameters gives a better estimate of overall survival compared with residual disease or necrosis alone.
Conclusion Integrated prognostic index improves prognostication in patients treated for osteosarcoma.
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Affiliation(s)
- Navatha Vangala
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G. Uppin
- Department of Pathology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - K. Nageshwara Rao
- Department of Orthopaedics, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - P. Chandrasekhar
- Department of Orthopaedics, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashivudu Gundeti
- Department of Medical Oncology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India
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Correlation between Prognostic Factors and the Histopathological Response to Neoadjuvant Chemotherapy in Osteosarcoma: A Retrospective Study. Int J Surg Oncol 2021; 2021:8843325. [PMID: 33996154 PMCID: PMC8096583 DOI: 10.1155/2021/8843325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Multimodality treatment, incorporating neoadjuvant chemotherapy and adjuvant chemotherapy, is the standard management plan for osteosarcoma that increases the overall survival (OS) rate. However, data regarding prognostic factors affecting the histopathological response following neoadjuvant chemotherapy is limited. Patients and Methods. We retrospectively reviewed patients diagnosed with osteosarcoma in our center between 2008 and 2018. We classified patient characteristics according to gender, age, tumor size, site and stage at diagnosis, site of metastasis, type of surgery, necrosis rate based on the Huvos grading system, and the number of neoadjuvant chemotherapy cycles. We divided response to neoadjuvant chemotherapy into poor responder for patients with Huvos grades 1 and 2 and good responder for patients with Huvos grades 3 and 4. We also documented patients' survival and follow-up information. Results We reviewed 64 patients within 5–65 years of age, dominated by men (62.5%). The distal femur (53.1%) was the most common site of osteosarcoma. Fifteen (23.4%) patients had a good response while 49 (76.6%) patients were poor responders to neoadjuvant chemotherapy based on the Huvos grading system. Based on multivariate analysis, gender (p = 0.012), age (p = 0.029), symptom duration (p = 0.004), and tumor enlargement after neoadjuvant chemotherapy (p < 0.001) were significantly associated with histopathological response. A scoring system was proposed integrating these significant variables (age > 20 years = 1 point, female gender = 1 point, symptom duration > 12 weeks = 1 point, and increased tumor size after neoadjuvant chemotherapy = 2 points). This scoring system divides patients into two groups with a total score of more than two predicting a poor responder to neoadjuvant chemotherapy. Conclusions Age, gender, symptoms duration, and tumor size after neoadjuvant chemotherapy are the prognostic features that affect the histopathological response to neoadjuvant chemotherapy in patients with osteosarcoma.
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Evenhuis RE, Acem I, Rueten-Budde AJ, Karis DSA, Fiocco M, Dorleijn DMJ, Speetjens FM, Anninga J, Gelderblom H, van de Sande MAJ. Survival Analysis of 3 Different Age Groups and Prognostic Factors among 402 Patients with Skeletal High-Grade Osteosarcoma. Real World Data from a Single Tertiary Sarcoma Center. Cancers (Basel) 2021; 13:486. [PMID: 33513855 PMCID: PMC7865349 DOI: 10.3390/cancers13030486] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 12/18/2022] Open
Abstract
Age is a known prognostic factor for many sarcoma subtypes, however in the literature there are limited data on the different risk profiles of different age groups for osteosarcoma survival. This study aims to provide an overview of survival in patients with high-grade osteosarcoma in different age groups and prognostic variables for survival and local control among the entire cohort. In this single center retrospective cohort study, 402 patients with skeletal high-grade osteosarcoma were diagnosed and treated with curative intent between 1978 and 2017 at the Leiden University Medical Center (LUMC). Prognostic factors for survival were analyzed using a Cox proportional hazard model. In this study poor overall survival (OS) and event-free survival (EFS) were associated with increasing age. Age groups, tumor size, poor histopathological response, distant metastasis (DM) at presentation and local recurrence (LR) were important independent prognostic factors influencing OS and EFS. Differences in outcome among different age groups can be partially explained by patient and treatment characteristics.
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Affiliation(s)
- Richard E. Evenhuis
- Department of Orthopedic Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (I.A.); (D.S.A.K.); (D.M.J.D.); (M.A.J.v.d.S.)
| | - Ibtissam Acem
- Department of Orthopedic Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (I.A.); (D.S.A.K.); (D.M.J.D.); (M.A.J.v.d.S.)
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, 3000CB Rotterdam, The Netherlands
| | - Anja J. Rueten-Budde
- Department of Biomedical Data Science, Section Medical Statistics and Bioinformatics, Mathematical Institute Leiden University, 2300RC Leiden, The Netherlands; (A.J.R.-B.); (M.F.)
| | - Diederik S. A. Karis
- Department of Orthopedic Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (I.A.); (D.S.A.K.); (D.M.J.D.); (M.A.J.v.d.S.)
| | - Marta Fiocco
- Department of Biomedical Data Science, Section Medical Statistics and Bioinformatics, Mathematical Institute Leiden University, 2300RC Leiden, The Netherlands; (A.J.R.-B.); (M.F.)
| | - Desiree M. J. Dorleijn
- Department of Orthopedic Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (I.A.); (D.S.A.K.); (D.M.J.D.); (M.A.J.v.d.S.)
| | - Frank M. Speetjens
- Department of Medical Oncology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (F.M.S.); (H.G.)
| | - Jakob Anninga
- Princess Máxima Center for Pediatric Oncology, 3720AC Utrecht, The Netherlands;
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (F.M.S.); (H.G.)
| | - Michiel A. J. van de Sande
- Department of Orthopedic Surgery, Leiden University Medical Center, 2300RC Leiden, The Netherlands; (I.A.); (D.S.A.K.); (D.M.J.D.); (M.A.J.v.d.S.)
- Princess Máxima Center for Pediatric Oncology, 3720AC Utrecht, The Netherlands;
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Maleki Dana P, Hallajzadeh J, Asemi Z, Mansournia MA, Yousefi B. Chitosan applications in studying and managing osteosarcoma. Int J Biol Macromol 2020; 169:321-329. [PMID: 33310094 DOI: 10.1016/j.ijbiomac.2020.12.058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023]
Abstract
Osteosarcoma has a high prevalence among children and adolescents. Common treatments of this disease are not promising enough. Molecular processes involved in the pathogenesis of osteosarcoma are not fully understood. Besides, the remnants of tumor cells after surgery can cause bone destruction and recurrence of the disease. Thus, there is a need to develop novel drugs or enhancing the currently-used drugs as well as identifying bone-repairing methods. Chitosan is a natural compound produced by the deacetylation of chitin. Research has shown that chitosan can be used in various fields due to its beneficial effects, such as biodegradability and biocompatibility. Regarding cancer, chitosan exerts several anti-tumor activities. Moreover, it can be used in diagnostic techniques, drug delivery systems, and cell culture methods. Herein, we aim to discuss the potential roles of chitosan in studying and treating osteosarcoma. We review the literature on chitosan's applications as a drug delivery system and how it can be combined with other substances to improve its ability of local drug delivery. We take a look into the studies concerning the possible benefits of chitosan in the field of bone tissue engineering and 3D culturing. Furthermore, anti-cancer activities of different compounds of chitosan are reviewed.
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Affiliation(s)
- Parisa Maleki Dana
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Jamal Hallajzadeh
- Department of Biochemistry and Nutrition, Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, Maragheh, Iran.
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Yousefi
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Yi X, Wang Y, Xu S. MiR-455-3p downregulation facilitates cell proliferation and invasion and predicts poor prognosis of osteosarcoma. J Orthop Surg Res 2020; 15:454. [PMID: 33008443 PMCID: PMC7532597 DOI: 10.1186/s13018-020-01967-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 01/07/2023] Open
Abstract
Background Osteosarcoma (OS) is one of the most primary malignant bone tumors, mainly attracting children and young adults. The microRNAs are mentioned to play vital roles in many cancers, including OS. The purpose of this study was to explore the expression and function of miR-455-3p in OS and predict the potential effects in clinical diagnosis and prognosis. Method We conducted quantitative real-time PCR to assess the expression of miR-455-3p in OS tissues and cell lines. The Cell Counting Kit-8 assay, Transwell assay, and flow cytometry were performed to assess the ability of miR-455-3p on cell proliferation, migration, invasion, and apoptosis. Kaplan–Meier curve and Cox regression analysis were used to demonstrate the survival outcome. Results This study revealed that the expression of miR-455-3p was decreased in OS tissues and cell lines. The dysregulation of miR-455-3p was in association with tumor size, distant metastasis, and clinical stage. Patients with high miR-455-3p expression had a satisfying survival rate. Multivariate Cox analysis indicated that miR-455-3p was a promising prognostic indicator. Expression of miR-455-3p could inhibit the proliferation, migration, and invasion, and facilitate apoptosis of OS cells in vitro. Conclusion These results indicated the miR-455-3p was a potential clinical therapeutic target and prognostic biomarker by suppressing the proliferation, migration, and invasion, as well as enhancing cell apoptosis.
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Affiliation(s)
- Xijun Yi
- Department of Comprehensive Orthopedics, Linyi People's Hospital, Linyi, 276000, Shandong, China
| | - Yafei Wang
- Prison Hospital, Linyi People's Hospital, Linyi, 276000, Shandong, China
| | - Shijie Xu
- Second Department of Traumatology, Linyi People's Hospital, Linyi, 276000, Shandong, China.
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Aran V, Meohas W, de Sá Lopes AC, Maciel Cabral L, Fortuna-Costa A, Matheus Guimarães JA, Leite Duarte ME. Multicentric chondrosarcoma involving the appendicular skeleton: a case report and literature review. Curr Oncol 2020; 27:281-284. [PMID: 33173382 PMCID: PMC7606051 DOI: 10.3747/co.27.6237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Chondrosarcomas constitute the 3rd most common primary bone malignancy. These tumours grow slowly and rarely metastasize, usually having a good prognosis after surgery. Among patients registered and treated at the Brazilian National Institute of Traumatology and Orthopedics, an uncommon case of chondrosarcoma was identified in a 63-year-old man, who was diagnosed with multicentric chondrosarcoma of the appendicular skeleton. This example is atypical in the medical literature because multicentric tumours are different from metastatic events, and their frequency in chondrosarcoma is rare. This article therefore provides a rare case report alongside a review of additional cases in the medical literature.
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Affiliation(s)
- V Aran
- Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - W Meohas
- Department of Oncology, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - A C de Sá Lopes
- Department of Oncology, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - L Maciel Cabral
- Department of Pathology, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - A Fortuna-Costa
- Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - J A Matheus Guimarães
- Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
| | - M E Leite Duarte
- Research Division, National Institute of Traumatology and Orthopaedics, Rio de Janeiro, Brazil
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Han J, Yu Y, Wu S, Wang Z, Zhang W, Zhao M, Yao Y, Hu Y, Wang W, Liu X, Yu W, Cheng J, Yu L, Bao Q, Zhang G, Yu X, Song R. Clinical factors affecting prognosis of limb osteosarcoma in China: a multicenter retrospective analysis. J Int Med Res 2020; 48:300060520930856. [PMID: 32865070 PMCID: PMC7469730 DOI: 10.1177/0300060520920053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective This study was performed to explore the relationship between various clinical factors and the prognosis of limb osteosarcoma. Methods We retrospectively analyzed the clinical data of 336 patients with limb osteosarcoma treated from June 2000 to August 2016 at 7 Chinese cancer centers. Data on the patients’ clinical condition, treatment method, complications, recurrences, metastasis, and prognosis were collected and analyzed. Kaplan–Meier analysis and Cox regression models were used to analyze the data. Results The patients comprised 204 males and 132 females ranging in age from 6 to 74 years (average, 21.1 years). The overall 3- and 5-year survival rates were 65.0% and 55.0%, respectively. The 5-year overall survival rate was 64.0% with standard chemotherapy and 45.6% with non-standard chemotherapy. Cox regression analysis demonstrated that standard chemotherapy, surgery, recurrence, and metastasis were independent factors associated with the prognosis of limb osteosarcoma. Conclusion The survival of patients with limb osteosarcoma can be significantly improved by combining standard chemotherapy and surgery. The overall survival rate can also be improved by adding methotrexate to doxorubicin–cisplatin–ifosfamide triple chemotherapy.
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Affiliation(s)
- Jia Han
- Department of Orthopedics, PLA 960th Hospital, Jinan City, Shandong Province, China
| | - Yiyang Yu
- Department of Bone Oncology, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Sujia Wu
- Department of Orthopedics, East Region Military Command General Hospital, Nanjing, Jiangsu, China
| | - Zhen Wang
- Department of Bone Oncology, Xijing Hospital, Xian, Shaanxi, China
| | - Weibin Zhang
- Department of Orthopaedics, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Ming Zhao
- Department of Bone Oncology, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Yang Yao
- Department of Oncology, Shanghai 6th People's Hospital Affiliated to Shanghai Jiao Tong University School, Shanghai, China
| | - Yongcheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Wenjian Wang
- Department of Orthopedics, PLA 960th Hospital, Jinan City, Shandong Province, China
| | - Xiaozhou Liu
- Department of Orthopedics, East Region Military Command General Hospital, Nanjing, Jiangsu, China
| | - Wenxi Yu
- Department of Oncology, Shanghai 6th People's Hospital Affiliated to Shanghai Jiao Tong University School, Shanghai, China
| | - Jie Cheng
- Department of Bone Oncology, Xijing Hospital, Xian, Shaanxi, China
| | - Lili Yu
- Department of Information, PLA 960th Hospital, Jinan, Shandong, China
| | - Qiyuan Bao
- Department of Orthopaedics, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Guochuan Zhang
- Department of Bone Oncology, Hebei Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Xiuchun Yu
- Department of Orthopedics, PLA 960th Hospital, Jinan City, Shandong Province, China
| | - Ruoxian Song
- Department of Orthopedics, PLA 960th Hospital, Jinan City, Shandong Province, China
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Characterization of PD-1/PD-L1 Immune Checkpoint Expression in Osteosarcoma. Diagnostics (Basel) 2020; 10:diagnostics10080528. [PMID: 32751195 PMCID: PMC7459780 DOI: 10.3390/diagnostics10080528] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 01/01/2023] Open
Abstract
Recent data have suggested that PD-1 and PD-L1 are involved in osteosarcoma (OS) pathogenesis; however, their contributions are not well-established. Here, the PD-1/PD-L1 expression was evaluated in (OS) cases. Preoperative needle biopsy specimens were obtained from 16 patients with OS. Immunostaining for CD4, CD8, PD-1, and PD-L1 was performed on pathological specimens. Clinical parameters, including age, tumor size, preoperative alkaline phosphatase (ALP) level, standardized uptake value (SUV)-max level, and survival rate, were compared between PD-1/PD-L1-positive and -negative groups. CD4-, CD8-, PD-1-, and PD-L1-positive rates among all specimens were 75%, 75%, 18.7%, and 62.5%, respectively. The rates of co-expression of CD4 and CD8 with PD-L1 were 56.2% and 50%, respectively. Tumors were significantly larger in PD-L1-negative cases than in PD-L1-positive cases. Age, size and ALP and SUV-max levels did not differ significantly between PD-1/PD-L1-positive and -negative cases. The 3-year survival rates did not differ significantly between PD-1-positive and -negative cases or between PD-L1-positive and -negative cases. However, the occurrence of cancer-related events, including recurrence, metastasis, and death was associated with the PD-1-negative and PD-L1-positive status. The PD-1/PD-L1 checkpoint is likely involved in the immune microenvironment in OS and may be involved in the occurrence of cancer-related events.
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18
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Tsuda Y, Tsoi K, Parry MC, Stevenson JD, Fujiwara T, Sumathi V, Jeys LM. Impact of chemotherapy-induced necrosis on event-free and overall survival after preoperative MAP chemotherapy in patients with primary high-grade localized osteosarcoma. Bone Joint J 2020; 102-B:795-803. [PMID: 32475245 DOI: 10.1302/0301-620x.102b6.bjj-2019-1307.r1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To assess the correlation between the histological response to preoperative chemotherapy and event-free survival (EFS) or overall survival (OS) in patients with high-grade localized osteosarcoma. METHODS Out of 625 patients aged ≤ 40 years treated for primary high-grade osteosarcoma between 1997 and 2016, 232 patients without clinically detectable metastases at the time of diagnosis and treated with preoperative high-dose methotrexate, adriamycin and cisplatin (MAP) chemotherapy and surgery were included. Associations of chemotherapy-induced necrosis in the resected specimen and EFS or OS were assessed using Cox model and the Pearson's correlation coefficients (r). Time-dependent receiver operating characteristic analysis was applied to determine the optimal cut-off value of chemotherapy-induced necrosis for EFS and OS. RESULTS OS was 74% (95% confidence interval (CI) 67 to 79) at five years. Median chemotherapy-induced necrosis was 85% (interquartile range (IQR) 50% to 97%). In multivariate Cox model, chemotherapy-induced necrosis was significantly associated with EFS and OS (hazard ratio (HR) = 0.99 (95% CI 0.98 to 0.99); p < 0.001 and HR = 0.98 (95% CI 0.97 to 0.99); p < 0.001, respectively). Positive correlation was observed between chemotherapy-induced necrosis and five-year EFS and five-year OS (r = 0.91; p < 0.001, and r = 0.85; p < 0.001, respectively). The optimal cut-off value of chemotherapy-induced necrosis for five-year EFS and five-year OS was 85% and 72%, respectively. CONCLUSION Chemotherapy-induced necrosis in the resected specimen showed positive correlation with EFS and OS in patients with high-grade localized osteosarcoma after MAP chemotherapy. In our analysis, optimal cut-off values of MAP chemotherapy-induced necrosis in EFS and OS were lower than the commonly used 90%, suggesting the need for re-evaluation of the optimal cut-off value through larger, international collaborative research. Cite this article: Bone Joint J 2020;102-B(6):795-803.
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Affiliation(s)
- Yusuke Tsuda
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Kim Tsoi
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Michael C Parry
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Birmingham, UK
| | - Jonathan D Stevenson
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Aston University Medical School, Birmingham, UK
| | | | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital, Birmingham, UK
| | - Lee M Jeys
- Department of Oncology, Royal Orthopaedic Hospital, Birmingham, UK.,Life & Health Sciences at University of Aston, Birmingham, UK
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Jettoo P, Tan G, Gerrand CH, Rankin KS. Role of routine blood tests for predicting clinical outcomes in osteosarcoma patients. J Orthop Surg (Hong Kong) 2020; 27:2309499019838293. [PMID: 30909848 DOI: 10.1177/2309499019838293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This retrospective cohort study aimed to investigate whether simple routine blood tests at presentation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alkaline phosphatase and albumin) predict survival in patients with osteosarcoma. METHODS Between January 1998 and February 2015, 134 patients with a histological diagnosis of osteosarcoma were treated in our unit. Of these, 79 patients with high-grade osteosarcomas were included in the study. Demographic and clinical data, and laboratory parameters obtained prior to biopsy (CRP, ESR, alkaline phosphatase and albumin levels), were obtained from patients' records. RESULTS There were 44 males and 35 females. Univariate analysis showed that high pre-biopsy CRP ( p = 0.004), raised pre-biopsy ESR ( p = 0.010), older age ( p < 0.001), poor tumour necrosis rates (≤90%, p = 0.023) and metastasis at presentation ( p < 0.001) were poor prognostic factors. Multivariate analysis showed pre-biopsy CRP and ESR levels to be independent predictors of overall survival ( p = 0.020 and p = 0.025, respectively). Kaplan-Meier survival was significantly lower in patients with elevated CRP ( p = 0.002) and ESR ( p = 0.003). Hypoalbuminaemia and elevated alkaline phosphatase levels did not correlate with overall survival. CONCLUSION Preoperative CRP and ESR levels may have value in building a prognostic model for patients presenting with osteosarcoma.
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Affiliation(s)
- P Jettoo
- 1 Northern Deanery Training Programme, Newcastle upon Tyne, UK
| | - Gjs Tan
- 2 East Suffolk & North Essex NHS Foundation Trust, The Ipswich Hospital, Ipswich, UK
| | - C H Gerrand
- 3 Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, UK
| | - K S Rankin
- 4 North of England Bone and Soft Tissue Tumour Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,5 Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
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Abstract
AIM The aims of this study were to assess survival outcome of pediatric patients with localized osteosarcoma of the extremities in Upper Egypt, identify factors of prognostic significance for survival, and to determine factors predictive of surgical methods used in these patients, as well as developing a clinical model for risk prediction. PATIENTS AND METHODS A retrospective analysis of data assembled from medical records of 30 pediatric patients with a histologically verified nonmetastatic osteosarcoma of the extremities treated at South Egypt Cancer Institute with a unified chemotherapy protocol between January 2001 and December 2015 was carried out. Prognostic factors were determined using univariable and multivariable methods. A model for surgical outcomes in these patients based on the baseline clinical factors, and the parameters predictive of their tumor response to chemotherapy, was developed. RESULTS With a median follow-up of 63 months for the study population, the estimates for event-free survival and overall survival (OS) at 3 and 5 years were 69.5% and 79% and 65.2% and 65.3%, respectively. Age 16 years or above was independently associated with both worse metastasis-free survival (hazard ratio [HR]=6.05, 95% confidence interval [CI]: 1.43-25.6, P=0.015) and OS (HR=7.9, 95% CI: 1.71-36.2, P=0.008). In the multivariable analysis, a proximal location within the limb gained a statistical significance to be independently associated with worse OS (HR=2.4, 95% CI: 1.13-22.1, P=0.003). Poor response to chemotherapy was marginally associated with worse metastasis-free survival (HR=4.9, 95% CI: 1.02-23.8, P=0.047) only in the univariable analysis. The patients found to be more likely to undergo an amputation surgery (odds ratio=14.1, 95% CI: 1.34-149.4, P=0.028) were those in whom a tumor was poorly responding to chemotherapy. CONCLUSION In Upper Egypt, despite the reasonable survival outcomes in nonmetastatic osteosarcoma, a relatively high limb amputation rate has been encountered. The development of a clinical prediction model for future planning of possible outcome improvement in these patients, however, is still feasible.
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Xin S, Wei G. Prognostic factors in osteosarcoma: A study level meta-analysis and systematic review of current practice. J Bone Oncol 2020; 21:100281. [PMID: 32140401 PMCID: PMC7047183 DOI: 10.1016/j.jbo.2020.100281] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 12/23/2022] Open
Abstract
Background A consensus has not yet been reached regarding the abilities of gender, age, tumor size, tumor location, histologic subtypes, and surgery in the prediction of survival in osteosarcoma. We aimed to disclose their prognostic significance by conducting a meta-analysis of all the published data from the last decade. Materials and Methods Electronic database searches were conducted in PubMed, Embase, and Web of Science for relevant articles published within the last ten years. The pooled hazard ratio (HR) and corresponding 95% confidence interval (CI) were obtained to evaluate the prognostic values of the target factors. Results A total of 18,126 patients from 40 studies were eventually included. Results indicated that gender (male vs. female: 1.21, 95% CI, 1.11–1.32; female vs. male: 0.85, 95% CI, 0.75–0.98), age (12–20 vs. ≤12: 1.37, 95% CI, 1.13–1.65; ≥20 vs. <20: 1.29, 95% CI, 1.08–1.55; ≥40 vs. <40: 1.63, 95% CI, 1.21–2.20; ≥50 vs. <25: 2.60, 95% CI, 1.92–3.53; ≥60 vs. <60: 1.11, 95% CI, 1.06–1.18), tumor location (non-extremities vs. extremities: 2.10, 95% CI, 1.76–2.51; proximal vs. distal femur: 3.68, 95% CI: 1.51–8.96; proximal vs. distal humerus: 3.15, 95% CI: 1.53–6.49), tumor size (≥5 vs. <5: 1.42, 95% CI, 1.09–1.86; >8 vs. ≤8: 1.55, 95% CI, 1.07–2.24; >9 vs. ≤9: 1.44, 95% CI, 1.05–1.96), chemotherapy response (poor vs. good: 2.45, 95% CI, 2.02–2.97; good vs. poor: 0.41, 95% CI, 0.34–0.48), and surgery (yes vs. no: 0.45, 95% CI, 0.36–0.57; amputation vs. salvage: 2.34, 95% CI, 1.47–3.74) were significantly associated with overall survival in osteosarcoma patients. Conclusion The meta-analysis demonstrated that male patients, older age, large tumor size, non-extremity osteosarcoma, proximal osteosarcoma, poor chemotherapy response, no surgical treatment, and amputation surgery were correlated with a poor prognosis in osteosarcoma patients.
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Affiliation(s)
- Sun Xin
- Orthopedic Oncology, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing 100044, China
| | - Guo Wei
- Orthopedic Oncology, Peking University People's Hospital, No.11, Xizhimen South Street, Xicheng District, Beijing 100044, China
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Kelley LM, Schlegel M, Hecker-Nolting S, Kevric M, Haller B, Rössig C, Reichardt P, Kager L, Kühne T, Gosheger G, Windhager R, Specht K, Rechl H, Tunn PU, Baumhoer D, Wirth T, Werner M, von Kalle T, Nathrath M, Burdach S, Bielack S, von Lüttichau I. Pathological Fracture and Prognosis of High-Grade Osteosarcoma of the Extremities: An Analysis of 2,847 Consecutive Cooperative Osteosarcoma Study Group (COSS) Patients. J Clin Oncol 2020; 38:823-833. [PMID: 31928458 DOI: 10.1200/jco.19.00827] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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.
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Affiliation(s)
- Lisa Marie Kelley
- 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
| | - Miriam Schlegel
- 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
| | - Stefanie Hecker-Nolting
- Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany
| | - Matthias Kevric
- Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany
| | - Bernhard Haller
- Institute for Medical Informatics, Statistics, and Epidemiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claudia Rössig
- Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
| | - Peter Reichardt
- Helios Klinikum Berlin-Buch, Klinik für Onkologie und Palliativmedizin, Berlin, Germany
| | - Leo Kager
- Department of Pediatrics, St Anna Children's Hospital, Medical University Vienna, Vienna, Austria
| | - Thomas Kühne
- Pediatric Oncology and Hematology, Universitäts-Kinderspital beider Basel, Basel, Switzerland
| | - Georg Gosheger
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
| | - Reinhard Windhager
- Allgemeines Krankenhaus der Stadt Wien, Universitätsklinik für Orthopädie der Medizinischen Universität Wien, Vienna, Austria
| | - Katja Specht
- Technische Universität München, Institut für Allgemeine Pathologie und Pathologische Anatomie, Munich, Germany
| | - Hans Rechl
- Department of Orthopedics and Sports Orthopedics, Technical University of Munich, Munich, Germany
| | - Per-Ulf Tunn
- Helios Klinikum Berlin-Buch, Klinik für Tumororthopädie, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
| | - Daniel Baumhoer
- Bone Tumor Reference Center at the Institute of Pathology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Thomas Wirth
- Klinik für Orthopädie, Olgahospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Mathias Werner
- Vivantes Klinikum im Friedrichshein, Institut für Pathologie, Osteopathologie-Referenzzentrum, Berlin, Germany
| | - Thekla von Kalle
- Radiological Institute, Klinikum Stuttgart, Olgahospital, Stuttgart, Germany
| | - Michaela Nathrath
- 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.,Pediatric Hematology and Oncology, Klinikum Kassel, Kassel, Germany
| | - Stefan Burdach
- 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
| | - Stefan Bielack
- Paediatrics 5, Oncology-Hematology-Immunology, Klinikum Stuttgart, Olgahospital Stuttgart, Cancer Center, Cooperative Osteosarcoma Study Group COSS, Stuttgart, Germany
| | - Irene von Lüttichau
- 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
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Pediatric Osteosarcoma of Extremities: A 15-year Experience From a Tertiary Care Cancer Center in Upper Egypt. J Pediatr Hematol Oncol 2019; 41:e371-e383. [PMID: 30629005 DOI: 10.1097/mph.0000000000001407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
AIM To assess the outcome and determine predictors of survival in pediatric patients with osteosarcoma of the extremities treated with a unified chemotherapy protocol at a single institution over a 15-year period. MATERIALS AND METHODS We performed a retrospective analysis of medical records of 48 pediatric patients with histologically verified osteosarcoma of the extremities diagnosed at South Egypt Cancer Institute and received treatment between January 2001 and December 2015. RESULTS With a median follow-up of 61 months for the entire cohort, estimates of overall survival (OS) for 3- and 5-year were 50.9% and 42.1%, respectively. While the estimates of OS for 3- and 5-year in the nonmetastatic group were 79% and 65.2%, respectively. In the multivariable analysis, both metastatic disease at diagnosis and poor response to chemotherapy retained their statistical significance as independent predictors for event-free survival. Whereas for OS, a metastatic disease at diagnosis remained as the lone predictor of a dismal outcome, while a poor response to chemotherapy became marginally associated with an inferior outcome. CONCLUSIONS In Upper Egypt, whereas slightly less than two thirds of children with localized osteosarcoma of extremities survives their disease, metastasis at presentation remains the key predictor of dismal survival outcomes.
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Huang R, Xian S, Shi T, Yan P, Hu P, Yin H, Meng T, Huang Z. Evaluating and Predicting the Probability of Death in Patients with Non-Metastatic Osteosarcoma: A Population-Based Study. Med Sci Monit 2019; 25:4675-4690. [PMID: 31231119 PMCID: PMC6604676 DOI: 10.12659/msm.915418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Osteosarcoma is one of the most common bone tumors, with strong local aggressiveness and early metastasis. The aim of this study was to describe the epidemiological data and evaluate the prognostic factors for overall survival (OS) and cause-specific survival (CSS) in patients with non-metastatic osteosarcoma. MATERIAL AND METHODS Patients histologically diagnosed with non-metastatic osteosarcoma between 2005 and 2014 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Survival analysis, machine learning, and Lasso regression were used to identify the prognostic factors for OS and CSS, and the accuracy of the nomograms was tested and compared with the American Joint Committee on Cancer (AJCC) staging systems. RESULTS The entire cohort comprised 1000 patients with non-metastatic osteosarcoma. The multivariable analysis suggested that age, tumor size, grade, and American Joint Committee on Cancer (AJCC) T staging were independent prognostic factors for OS and CSS. Additionally, the nomograms based on these results could better predict probability of OS (Internal validation C-index, 0.7095) and CSS (0.7100) compared with the sixth (OS: 0.613; CSS: 0.628) and seventh edition AJCC staging systems (0.602, 0.613). CONCLUSIONS Relatively young age and low histopathological grade were favorable factors for both OS and CSS. Nomograms based on multivariable models worked well in predicting the probability of death for patients with non-metastatic osteosarcoma.
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Affiliation(s)
- Runzhi Huang
- Division of Spine Surgery, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, China (mainland)
| | - Shuyuan Xian
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Tingting Shi
- Tongji University School of Medicine, Tongji University, Shanghai, China (mainland)
| | - Penghui Yan
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Peng Hu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
| | - Huabin Yin
- Department of Orthopedics, Shanghai Bone Tumor Institute, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Tong Meng
- Division of Spine Surgery, Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China (mainland).,Key Laboratory of Spine and Spinal cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, China (mainland)
| | - Zongqiang Huang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (mainland)
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Abstract
The aim of this study was to develop nomograms to predict long-term overall survival and cancer-specific survival of patients with osteosarcoma.We carried out univariate and multivariate analyses and set up nomograms predicting survival outcome using osteosarcoma patient data collected from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (2004-2011, n = 1426). The patients were divided into a training cohort (2004-2008, n = 863) and a validation cohort (2009-2011, n = 563), and the mean follow-up was 55 months.In the training cohort, 304 patients (35.2%) died from osteosarcoma and 91 (10.5%) died from other causes. In the validation cohort, 155 patients (27.5%) died from osteosarcoma and (12.3%) died from other causes. Nomograms predicting overall survival (OS) and cancer-specific survival (CSS) were developed according to 6 clinicopathologic factors (age, tumor site, historic grade, surgery, AJCC T/N, and M), with concordance indexes (C-index) of 0.725 (OS) and 0.718 (CSS), respectively. The validation C-indexes were 0.775 and 0.742 for OS and CSS, respectively.Our results suggest that we have successfully developed highly accurate nomograms for predicting 5-year OS and CSS for osteosarcoma patients. These nomograms will help surgeons customize treatment and monitoring strategies for osteosarcoma patients.
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Affiliation(s)
- Wenhao Chen
- Affiliated Union Hospital, Fujian Medical University, Department of Orthopedics
| | - Yuxiang Lin
- Affiliated Union Hospital, Fujian Medical University, Department of Breast Surgery, Fuzhou, China
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26
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Tempelaere C, Biau D, Babinet A, Anract P. Osteosarcoma after the age of fifty: A clinicopathological study. Eur J Surg Oncol 2019; 45:1288-1292. [PMID: 31014986 DOI: 10.1016/j.ejso.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/05/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Osteosarcoma, a primary malignant bone tumor, has a well-recognised double peak of incidence in early adolescence and after 50 years. This study investigates the clinical features and prognostic factors of patients older than 50 years with osteosarcoma. MATERIEL AND METHODS From January 2000 to December 2012, in one bone tumor reference center, 32 patients aged more than 50 years at the diagnosis (mean age: 62.4 years (50-85), sex ratio: 13 males, 19 females) diagnosed with osteosarcoma were included. Patients younger than 50 years at diagnosis or with a non-histologically proved osteosarcoma were excluded. For each patient, we registered medical history, tumor location, systemic and local extension, treatment, and survival. RESULTS 62% were located in the extremities and 28% in the axial skeleton. 6 were secondary sarcomas. Mean delay between first symptoms and biopsy was 7.4 months (range from 0 to 28 months). Ten patients had a systemic osteosarcoma with one or more pulmonary metastases. Six patients were treated with palliative care (18.8%). Eighteen patients received neodajuvant chemotherapy, sixteen of them received postoperative chemotherapy. Twenty-five patients had surgery. Postoperative complications were reported in eight cases (25%). Overall survival for all 31 patients was 25% at 5 years and 6.2% at 10 years. Survival without metastases was 15.6% at 5 years and nil at 10 years. Median survival time for the 22 localised osteosarcoma patients was 4 years (0.9-12.6) versus 1.2 years (0.3-12.3) for the 10 systemic osteosarcoma patients (p = 0.01). CONCLUSION Metastases at diagnosis, age, axial location are worse prognostic for survival.
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Affiliation(s)
- Christine Tempelaere
- Service d'orthopédie, Hôpital Cochin, AP-HP, Paris, France, Université Paris Descartes, Paris, France.
| | - David Biau
- Service d'orthopédie, Hôpital Cochin, AP-HP, Paris, France, Université Paris Descartes, Paris, France
| | - Antoine Babinet
- Service d'orthopédie, Hôpital Cochin, AP-HP, Paris, France, Université Paris Descartes, Paris, France
| | - Philippe Anract
- Service d'orthopédie, Hôpital Cochin, AP-HP, Paris, France, Université Paris Descartes, Paris, France
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27
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Song K, Song J, Chen F, Lin K, Ma X, Jiang J. Prognostic nomograms for predicting overall and cancer-specific survival of high-grade osteosarcoma patients. J Bone Oncol 2018; 13:106-113. [PMID: 30591864 PMCID: PMC6303413 DOI: 10.1016/j.jbo.2018.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/23/2018] [Accepted: 09/23/2018] [Indexed: 01/16/2023] Open
Abstract
Aim The present study aimed to develop nomograms estimating survival for patients with high-grade osteosarcoma. Methods 1990 patients with high-grade osteosarcoma between 1994 and 2013 were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Data from 12 cancer registries (n = 1460) were used to conduct multivariate Cox analysis to identify independent prognostic factors. Nomograms which estimate 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) were constructed. The nomograms were internally validated for calibration and were also externally validated with an independent patient cohort from 1 cancer registry (n = 530). Results Age, primary site, tumor size, use of surgery, and extent of disease were found to be independently associated with OS and CSS (p < 0.05). The nomograms estimating 3- and 5-year OS and CSS were developed based on these prognostic factors. The concordance indices were high in internal validation (0.726 for OS and 0.731 for CSS) and external validation (0.716 for OS and 0.724 for CSS). Internal and external calibration plots demonstrated a good agreement between nomogram prediction and actual observation. Conclusions We constructed nomograms that accurately predict OS and CSS of high-grade osteosarcoma patients. The nomograms can be used for counseling patients and establishing risk stratification.
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Affiliation(s)
- Kehan Song
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
| | - Jian Song
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
| | - Feiyan Chen
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
| | - Kaiyuan Lin
- Department of Orthopaedics, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China
| | - Xiaosheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
- Corresponding author.
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High-Grade Osteosarcoma of the Foot: Presentation, Treatment, Prognostic Factors, and Outcome of 23 Cooperative Osteosarcoma Study Group COSS Patients. Sarcoma 2018; 2018:1632978. [PMID: 29853778 PMCID: PMC5954899 DOI: 10.1155/2018/1632978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/15/2018] [Accepted: 03/18/2018] [Indexed: 11/21/2022] Open
Abstract
Osteosarcoma of the foot is a very rare presentation of a rare tumor entity. In a retrospective analysis, we investigated tumor- and treatment-related variables and outcome of patients registered in the Cooperative Osteosarcoma Study Group (COSS) database between January 1980 and April 2016 who suffered from primary high-grade osteosarcoma of the foot. Among the 23 eligible patients, median age was 32 years (range: 6–58 years), 10 were female, and 13 were male. The tarsus was the most commonly affected site (n=16). Three patients had primary metastases. All patients were operated: 5 underwent primary surgery and 18 received surgery following preoperative chemotherapy. In 21 of the 23 patients, complete surgical remission was achieved. In 4 of 17 patients, a poor response to neoadjuvant chemotherapy was observed in the resected primary tumors. Median follow-up was 4.2 years (range: 0.4–18.5). At the last follow-up, 15 of the 23 patients were alive and 8 had died. Five-year overall and event-free survival estimates were 64% (standard error (SE) 12%) and 54% (SE 13%), which is similar to that observed for osteosarcoma in general. Event-free and overall survival correlated with primary metastatic status and completeness of surgery. Our findings show that high-grade osteosarcoma in the foot has a similar outcome as osteosarcoma of other sites.
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Thanapprapasr K, Nartthanarung A, Thanapprapasr D, Jinawath A. pFAK-Y397 overexpression as both a prognostic and a predictive biomarker for patients with metastatic osteosarcoma. PLoS One 2017; 12:e0182989. [PMID: 28846700 PMCID: PMC5573209 DOI: 10.1371/journal.pone.0182989] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/27/2017] [Indexed: 11/18/2022] Open
Abstract
Focal adhesion kinase (FAK) is important for tumor cell survival and metastasis in various cancers. However, its expression and prognostic value in patients with metastatic osteosarcoma remain unknown. We investigated the expression of FAK and its phosphorylated form (pFAK-Y397) in osteosarcoma tissues from 53 patients by immunohistochemistry and evaluated their correlations with clinicopathologic characteristics and outcomes. The prognostic values were assessed using Kaplan-Meier survival and Cox regression analyses. Total FAK and pFAK-Y397 were overexpressed in 48 (90.6%) and 33 (62.3%) cases, respectively. pFAK-Y397 overexpression was correlated with poor histologic response after neoadjuvant chemotherapy in patients with osteosarcoma regardless of the presence of metastasis or not. Kaplan-Meier curve showed that patients with metastatic osteosarcoma with pFAK-Y397 overexpression had significantly worse overall survival (OS) than those with non-overexpression (P = 0.044). Multivariate Cox regression analysis confirmed pFAK-Y397 overexpression as an independent prognostic predictor for OS and post metastases OS (PMOS) (P = 0.017, P = 0.006, respectively). Age at diagnosis was also an independent indicator for PMOS (P = 0.003). However, total FAK expression was not correlated with any clinicopathologic characteristics or OS in patients with metastatic osteosarcoma. In conclusion, our findings identified FAK as a common aberrant protein overexpression in various subtypes of osteosarcoma. pFAK-Y397 overexpression can be used as a prognostic biomarker predicting poor OS for patients with metastatic osteosarcoma, and the expression of pFAK-Y397 differentiated good and poor responders to neoadjuvant chemotherapy.
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Affiliation(s)
- Kamolrat Thanapprapasr
- Biomedical Engineering Research Unit, National Metal and Materials Technology Center, National Science and Technology Development Agency, Pathumthani, Thailand
- * E-mail: (AJ); (KT)
| | - Adisak Nartthanarung
- Musculoskeletal Oncology Unit, Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Duangmani Thanapprapasr
- Surgical Oncology Unit, Wattanosoth Cancer Hospital, Bangkok Hospital Medical Center, Bangkok, Thailand
| | - Artit Jinawath
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail: (AJ); (KT)
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Puri A, Byregowda S, Gulia A, Crasto S, Chinaswamy G. A study of 853 high grade osteosarcomas from a single institution-
Are outcomes in Indian patients different? J Surg Oncol 2017; 117:299-306. [DOI: 10.1002/jso.24809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/24/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ajay Puri
- Tata Memorial Centre; HBNI; Mumbai India
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Miller BJ, Gao Y, Duchman KR. Socioeconomic measures influence survival in osteosarcoma: an analysis of the National Cancer Data Base. Cancer Epidemiol 2017; 49:112-117. [DOI: 10.1016/j.canep.2017.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/29/2017] [Accepted: 05/31/2017] [Indexed: 01/12/2023]
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Hart H, Parkes JD. Long-term outcomes in osteosarcoma patients in the Groote Schuur Hospital patient population: A retrospective review. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2017. [DOI: 10.4102/sajo.v1i0.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<strong>Background:</strong> Predictive factors for long-term outcomes in osteosarcoma patients are still controversial. There is no literature available regarding these factors in a patient population in a developing country.<br /><strong>Aim and setting:</strong> To determine the outcome of treatment of osteosarcoma patients treated at Groote Schuur Hospital from 1990 to 2012 in terms of locoregional control (LRC), disease-free survival (DFS) and overall survival (OS) and to determine the value of suggested predictive factors in this population.<br /><strong>Patients and methods:</strong> Retrospective review of all patients diagnosed with and treated for osteosarcoma at Groote Schuur Hospital between 1990 and 2012, considering OS, DFS and LRC. This review assesses the significance of suggested predictive factors from other studies, namely, HIV status, age at diagnosis, site of primary disease, type of chemotherapy used, response to chemotherapy and type of surgery in terms of OS, DFS and LRC.<br /><strong>Results:</strong> Forty-three patients with histologically confirmed osteosarcoma were treated at Groote Schuur Hospital between 1990 and 2012. Median 5 year OS was 57.8%. On univariate analysis, the site of disease was the only statistically significant predictive factor for prognosis.<br /><strong>Conclusion:</strong> On univariate analysis, patients with axial disease have a worse predicted prognosis than those with primary disease in their extremities. The clinical behaviour and long-term outcome after treatment of these patients with osteosarcoma are similar to that seen internationally.
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Abstract
Osteosarcoma (OS) is the most common primary malignancy of bone and patients with metastatic disease or recurrences continue to have very poor outcomes. Unfortunately, little prognostic improvement has been generated from the last 20 years of research and a new perspective is warranted. OS is extremely heterogeneous in both its origins and manifestations. Although multiple associations have been made between the development of osteosarcoma and race, gender, age, various genomic alterations, and exposure situations among others, the etiology remains unclear and controversial. Noninvasive diagnostic methods include serum markers like alkaline phosphatase and a growing variety of imaging techniques including X-ray, computed tomography, magnetic resonance imaging, and positron emission as well as combinations thereof. Still, biopsy and microscopic examination are required to confirm the diagnosis and carry additional prognostic implications such as subtype classification and histological response to neoadjuvant chemotherapy. The current standard of care combines surgical and chemotherapeutic techniques, with a multitude of experimental biologics and small molecules currently in development and some in clinical trial phases. In this review, in addition to summarizing the current understanding of OS etiology, diagnostic methods, and the current standard of care, our group describes various experimental therapeutics and provides evidence to encourage a potential paradigm shift toward the introduction of immunomodulation, which may offer a more comprehensive approach to battling cancer pleomorphism.
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Affiliation(s)
- Brock A Lindsey
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA.
| | - Justin E Markel
- Department of Orthopaedics, West Virginia University, Morgantown, WV, USA
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Wang W, Yang J, Wang Y, Wang D, Han G, Jia J, Xu M, Bi W. Survival and prognostic factors in Chinese patients with osteosarcoma: 13-year experience in 365 patients treated at a single institution. Pathol Res Pract 2016; 213:119-125. [PMID: 28040328 DOI: 10.1016/j.prp.2016.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 11/05/2016] [Accepted: 11/11/2016] [Indexed: 11/26/2022]
Abstract
This study was designed to retrospectively analyze the survival and prognostic factors in Chinese osteosarcoma patients received neoadjuvant chemotherapy or/and surgery in a single institution. A total of 365 patients with pathological proved osteosarcoma undergoing neoadjuvant chemotherapy or/and surgery in a single institution between December 1999 and December 2012 were retrospectively analyzed for the demographic, tumor-related, and treatment-related variables, prognostic factors for survival rate and chemotherapy response. There were 231 males and 134 females (ratio, 1.72:1). The average age was 21±10years, with peak age between 10 and 20 years old (62%, 226/365). Of 365 patients, 319 (87.4%) suffered from primary tumor only, and 46 (12.6%) had metastases upon initial presentation. The overall 5-year survival rate was 65%. Upon univariate analysis, tumor site (femur 60.3%; other long bone 70.2%; trunk 33.6%; P=0.012), primary metastases (yes 36.7%; no 68.9%; P=0.000), tumor response to preoperative chemotherapy (good 89.8%; poor 47.5%; P=0.001) and recurrence/metastases after treatment (yes 36.2%; no 63.8%; P=0.000) were associated with higher 5-year survival rate. All factors except tumor site maintained their significance in multivariate testing. Male sex and nonconventional subtype of tumor were related to a higher likelihood of poor chemotherapy response.The absence of metastases at initial presentation, negative local recurrence or metastases after treatment, and tumor response to chemotherapy are of independent prognostic value in osteosarcoma. The overall prognostic factors and survival in Chinese patients are similar to those patients reported in western countries.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Jing Yang
- Department of Anesthesiology, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Yun Wang
- Department of Pathology, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Dianjun Wang
- Department of Pathology, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Gang Han
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Jinpeng Jia
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Meng Xu
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China
| | - Wenzhi Bi
- Department of Orthopaedics, The General Hospital of Chinese People's Liberation Army, NO28 Fuxing Road, Beijing 100853, China.
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Chui MH, Kandel RA, Wong M, Griffin AM, Bell RS, Blackstein ME, Wunder JS, Dickson BC. Histopathologic Features of Prognostic Significance in High-Grade Osteosarcoma. Arch Pathol Lab Med 2016; 140:1231-1242. [PMID: 27552092 DOI: 10.5858/arpa.2015-0389-oa] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context .- In osteosarcoma treated with neoadjuvant chemotherapy the extent of tumor necrosis on resection is considered an indicator of treatment response, and this has been shown to correlate with survival in most but not all studies. Objective .- To identify additional histologic variables of prognostic significance in high-grade osteosarcoma. Design .- Slides of pretreatment biopsy and primary postneoadjuvant chemotherapy resections from 165 patients with high-grade osteosarcoma were reviewed. Univariate (Kaplan-Meier) and multivariate (Cox regression) analyses were performed to identify clinical and histomorphologic attributes associated with overall survival. Results .- Univariate analyses confirmed the prognostic significance of metastatic status on presentation, primary tumor size, anatomic site, and histologic subtype. Additionally, the identification of lymphovascular invasion, 10% or more residual viable tumor, and 10 or more mitoses per 10 high-powered fields assessed in posttreatment resections were associated with poor survival, retaining significance in multivariate analyses. Based on results from multivariate analysis, we developed a prognostic index incorporating primary tumor size and site, and significant histologic features assessed on resection (ie, lymphovascular invasion status, mitotic rate, and extent of viable tumor). This scoring system segregates patients into 3 risk categories with significant differences in overall survival and retained significance in an independent validation set of 42 cases. Conclusions .- The integration of clinical and microscopic features improves prognostication of patients with osteosarcoma.
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Gok Durnali A, Paksoy Turkoz F, Ardic Yukruk F, Tokluoglu S, Yazici OK, Demirci A, Bal O, Gundogdu Buyukbas S, Esbah O, Oksuzoglu B, Alkis N. Outcomes of Adolescent and Adult Patients with Lung Metastatic Osteosarcoma and Comparison of Synchronous and Metachronous Lung Metastatic Groups. PLoS One 2016; 11:e0152621. [PMID: 27167624 PMCID: PMC4864076 DOI: 10.1371/journal.pone.0152621] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 03/16/2016] [Indexed: 11/19/2022] Open
Abstract
Osteosarcomas with lung metastases are rather heterogenous group. We aimed to evaluate the clinicopathological characteristics and outcomes of osteosarcoma patients with lung metastases and to compare the synchronous and metachronous lung metastatic groups. A total of 93 adolescent and adult patients with lung metastatic osteosarcoma, from March 1995 to July 2011, in a single center, were included. Sixty-five patients (69.9%) were male. The median age was 19 years (range, 14–74). Thirty-nine patients (41.9%) had synchronous lung metastases (Group A) and 54 patients (58.1%) had metachronous lung metastases (Group B). The 5-year and 10-year post-lung metastases overall survival (PLM-OS) was 17% and 15%, respectively. In multivariate analysis for PLM-OS, time to lung metastases (p = 0.010), number of metastatic pulmonary nodules (p = 0.020), presence of pulmonary metastasectomy (p = 0.007) and presence of chemotherapy for lung metastases (p< 0.001) were found to be independent prognostic factors. The median PLM-OS of Group A and Group B was 16 months and 9 months, respectively. In Group B, the median PLM-OS of the patients who developed lung metastases within 12 months was 6 months, whereas that of the patients who developed lung metastases later was 16 months. Time to lung metastases, number and laterality of metastatic pulmonary nodules, chemotherapy for lung metastatic disease and pulmonary metastasectomy were independent prognostic factors for patients with lung metastatic osteosarcoma. The best PLM-OS was in the subgroup of patients treated both surgery and chemotherapy. The prognosis of the patients who developed lung metastases within 12 months after diagnosis was worst.
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Affiliation(s)
- Ayse Gok Durnali
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Fatma Paksoy Turkoz
- Department of Medical Oncology, Bahcesehir University, Istanbul, Turkey
- * E-mail:
| | - Fisun Ardic Yukruk
- Department of Pathology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Omer Kamil Yazici
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ayse Demirci
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Oznur Bal
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Selay Gundogdu Buyukbas
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Onur Esbah
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Berna Oksuzoglu
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Necati Alkis
- Department of Medical Oncology, Dr. A.Y. Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Chou YS, Yen CC, Chen WM, Lin YC, Wen YS, Ke WT, Wang JY, Liu CY, Yang MH, Chen TH, Liu CL. Cytotoxic mechanism of PLK1 inhibitor GSK461364 against osteosarcoma: Mitotic arrest, apoptosis, cellular senescence, and synergistic effect with paclitaxel. Int J Oncol 2016; 48:1187-94. [PMID: 26794530 DOI: 10.3892/ijo.2016.3352] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 12/19/2015] [Indexed: 11/06/2022] Open
Abstract
Polo-like kinase 1 (PLK1), a serine/threonine kinase and an oncogene, is crucial in regulating cell cycle progression. PLK1 also has been demonstrated as a potential target of osteosarcoma (OS) by using short hairpin RNA libraries in lentiviral vectors for screening of protein kinase. In preclinical studies, GSK461364, a potent and selective ATP-competitive PLK1 inhibitor, showed antiproliferative activity against multiple tumor cell lines. In the present study, we evaluated the expression level of PLK1 in OS and explored the cytotoxic mechanism of GSK461364 against OS. PLK1 was significantly overexpressed in OS compared with normal osteoblasts and other types of sarcoma. GSK461364 inhibited PLK1 and caused mitotic arrest by inducing G2/M arrest in OS cells. Moreover, GSK461364 exerted a cytotoxic effect by inducing apoptosis in OS, and induced cellular senescence in OS cell lines, as indicated by an increased senescence-associated β-galactosidase activity and enhanced DcR2 and interleukin-1α expression. In addition, we demonstrated a synergistic cytotoxic effect of GSK461364 and paclitaxel, possibly resulting from combined mitotic arrest. In conclusion, the present study revealed that PLK1 was overexpressed in OS and that GSK461364 exerted its cytotoxic effect on OS by inducing mitotic arrest and subsequent apoptosis and induced cellular senescence; therefore, senescence-associated markers can be used as treatment biomarkers, and a combination of GSK461364 and paclitaxel can potentially treat OS.
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Affiliation(s)
- Yi-Sheng Chou
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chueh-Chuan Yen
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Wei-Ming Chen
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yung-Chan Lin
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Yao-Shan Wen
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Wei-Ting Ke
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Jir-You Wang
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chun-Yu Liu
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Tain-Hsiung Chen
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Chien-Lin Liu
- Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Zheng YF, Lin J, Yang HL. Chondroblastic osteosarcoma secondary to fibrosarcoma: A case report and literature review. Oncol Lett 2016; 10:3573-3576. [PMID: 26788171 DOI: 10.3892/ol.2015.3792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/16/2015] [Indexed: 11/05/2022] Open
Abstract
Osteosarcoma, which is most common in non-blood systemic tumors, accounts for 20% of primary bone malignancies. Primary osteosarcoma usually occurs in young individuals aged 10-20 years, while secondary osteosarcoma is more common in the elderly. It had been reported that secondary osteosarcoma may be associated with osteofibrous dysplasia, bone infarction, chondrosarcoma or osteogenesis imperfecta. However, osteosarcoma secondary to fibrosarcoma has rarely been reported. The current study presents the rare case of a female with chondroblastic osteosarcoma secondary to fibrosarcoma. The patient was relatively young and suffered from more than one type of cancer. The course of the disease lasted for >20 years. This case study provides general knowledge of osteosarcoma, and discusses its clinical presentation, diagnosis, treatment and prognosis.
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Affiliation(s)
- Yi-Fei Zheng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jun Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Hui-Lin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Abstract
Osteosarcoma is the most common primary bone malignancy in children. Treatment has evolved to include systemic chemotherapy and local control surgery. Although survival improved initially in a drastic fashion with this approach, recent decades have seen little to no further gains in this area. Limb salvage surgery evolved with effective chemotherapy and advances in imaging, and continues to improve in the recent era. This article serves as a review of survival in high-grade osteosarcoma: prognostic factors, advances in chemotherapy and surgery, late effects of chemotherapy and surgery in survivors, and future directions.
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40
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Duchman KR, Gao Y, Miller BJ. Prognostic factors for survival in patients with high-grade osteosarcoma using the Surveillance, Epidemiology, and End Results (SEER) Program database. Cancer Epidemiol 2015; 39:593-9. [DOI: 10.1016/j.canep.2015.05.001] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/30/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
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O'Kane GM, Cadoo KA, Walsh EM, Emerson R, Dervan P, O'Keane C, Hurson B, O'Toole G, Dudeney S, Kavanagh E, Eustace S, Carney DN. Perioperative chemotherapy in the treatment of osteosarcoma: a 26-year single institution review. Clin Sarcoma Res 2015; 5:17. [PMID: 26175892 PMCID: PMC4501053 DOI: 10.1186/s13569-015-0032-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 06/30/2015] [Indexed: 11/26/2022] Open
Abstract
Background Chemotherapy in the multimodality treatment of osteosarcoma has improved survival. Reported outcomes on adult patients are limited. Poor necrosis rates post neoadjuvant chemotherapy (NAC) is considered an adverse prognostic factor and attempts have been made to improve survival in this group. Patients and methods Adult and young adult patients diagnosed with osteosarcoma between January 1986 and August 2012 were retrospectively reviewed. Patients identified were stratified according to stage (localised or metastatic) and age (≤40 and >40 years). Event free survival (EFS) and overall survival (OS) outcomes were determined. In patients with localised disease ≤40 years, survival was assessed according to necrosis rates post NAC (<90 and ≥90%). NAC consisted of two cycles of methotrexate alternating with doxorubicin/cisplatin (MAP) followed by definitive surgery. Those with ≥90% tumour necrosis continued on MAP. Patients with <90% necrosis received ifosfamide and etoposide (IE) post operatively. Results A total of 108 patients were reviewed and 97 were included. Median age was 23 years (range 16–75) and 70% of patients were male. Five year EFS and OS across all groups was 57% and 63% respectively. Of the patients with localised disease (N = 81), 5-year overall survival (OS), with a median follow up of 7 years (2–26) was 70% (p < 0.0001). Patients aged 16–40 (N = 68) with localised osteosarcoma had a significantly improved 5-year OS (74%) compared to those >40 years (N = 13) (42%) (p = 0.004). Of the 68 patients with localised osteosarcoma ≤40 years, 62 were evaluated according to necrosis rates post MAP. In 33 patients who achieved ≥90% necrosis and continued MAP, 5-year OS was 82%. In 29 patients who had <90% tumour necrosis and received adjuvant IE, 5-year OS was 68% (p = 0.15). Multivariate analysis confirmed age and stage as prognostic factors but not poor necrosis rates in our treated population. Conclusions Long-term survival outcomes in a predominantly adult Irish population are similar to large reported trials. Age and stage at diagnosis are prognostic. Postoperative ifosfamide/etoposide alone in patients with poor necrosis rates is a feasible regimen, but its role in the adjuvant setting remains uncertain. Electronic supplementary material The online version of this article (doi:10.1186/s13569-015-0032-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G M O'Kane
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - K A Cadoo
- Gynaecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Centre, 300 East 66th Street, New York, NY 10065 USA
| | - E M Walsh
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - R Emerson
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - P Dervan
- Department of Histopathology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - C O'Keane
- Department of Histopathology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - B Hurson
- Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
| | - G O'Toole
- Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
| | - S Dudeney
- Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Finglas, Dublin 11, Ireland
| | - E Kavanagh
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - S Eustace
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - D N Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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Eleutério SJP, Senerchia AA, Almeida MT, Da Costa CM, Lustosa D, Calheiros LM, Barreto JHS, Brunetto AL, Macedo CRPD, Petrilli AS. Osteosarcoma in patients younger than 12 years old without metastases have similar prognosis as adolescent and young adults. Pediatr Blood Cancer 2015; 62:1209-13. [PMID: 25755160 DOI: 10.1002/pbc.25459] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/08/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Childhood cancer is relatively rare and tends to present specific age distribution, as a prognostic factor for some of these diseases. Information on how young age affects prognosis, response to chemotherapy, and local control options in children versus AYA with osteosarcoma (OST) is minimal. METHODS In order to identify the main differences in clinical pathologic features, surgical approaches and survival rates of primary high grade OST of the extremity between children (n = 156; <12 years old) and AYA (n = 397; 12-30 years old), the institutional database with 553 patients treated by BOTG studies over 15 years were reviewed. RESULTS There were no differences in metastases at diagnosis, tumor size, and grade of necrosis between the two age groups. The rate of amputation was 30% higher in the children group (P = 0.018). The rate of limb salvage surgery using reconstruction with allograft or autograft was 70% higher in the children group (P = 0.018) while endoprosthesis rate was 40% higher in the AYA group (P = 0.018). The log rank test revealed that survival is similar between the two age groups for non-metastatic patients (P = 0.424 for OS and P = 0.393 for EFS). Metastatic patients of both ages group had higher risk of dying compared to non-metastatic (HR 3.283 95% CI 2.581-4.177; P < 0.001). Children with metastases at diagnosis had less OS time (P = 0.049) and EFS time (P = 0.032) than adolescents. CONCLUSION Non-metastatic OST in preadolescent patients does not appear to be significantly different from those seen in AYA patients, but has local control challenges. Children presenting with metastases should be considered an ultra-high-risk group.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Antonio Sergio Petrilli
- Institutode Oncologia Pediatrica/GRAACC-Universidade Federal de Sao Paulo, Sao Paulo, Brazil
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Surgical outcome of malignant primary bone tumours in elderly and very elderly patients. INTERNATIONAL ORTHOPAEDICS 2014; 38:2149-54. [DOI: 10.1007/s00264-014-2400-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/28/2014] [Indexed: 10/25/2022]
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44
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Proximal tumor location and fluid-fluid levels on MRI predict resistance to chemotherapy in stage IIB osteosarcoma. Clin Orthop Relat Res 2014; 472:1911-20. [PMID: 24574120 PMCID: PMC4016442 DOI: 10.1007/s11999-014-3521-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 02/07/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary tumor growth during neoadjuvant chemotherapy is believed to be a sign of resistance to chemotherapy (chemoresistance), and often is associated with poor histologic response, local recurrence, and poorer survival. Currently there are no proven indicators to predict poor response to chemotherapy at the time of diagnosis. QUESTIONS/PURPOSES We asked (1) what clinicopathologic factors present at diagnosis predict primary tumor growth during neoadjuvant chemotherapy, (2) what factors at presentation predict survival, and (3) when the factors at presentation and the treatment-related factors are considered, what factors independently correlate with survival. METHODS We studied 567 patients with Stage IIB osteosarcomas. The factors assessed included age, sex, location, pattern on plain radiographs (radiodense, radiolucent, mixed), MRI findings, pathologic subtype, initial tumor volume determined by MRI, tumor volume change after chemotherapy, surgical margin, and histologic response to preoperative chemotherapy. Logistic modeling was used to identify risk factors. RESULTS Independent risk factors associated with primary tumor growth after neoadjuvant chemotherapy were proximal tumor location (p < 0.01; relative risk [RR], 2.41; 95% CI, 1.5-3.86) and fluid-fluid level on initial MRI (p < 0.01; RR, 5.56; 95% CI, 3.48-8.87). Among factors at presentation, large initial tumor volume (p < 0.01; RR, 1.58; 95% CI, 1.22-2.04), proximal tumor site (p < 0.01; RR, 1.61; 95% CI, 1.19-2.19), and presence of fluid-fluid level (p < 0.01; RR, 1.83; 95% CI, 1.37-2.5) independently predicted reduced event-free survival. When we consider the factors at presentation and treatment-related factors, large initial tumor volume (p < 0.01; RR, 1.54), tumor growth after neoadjuvant chemotherapy (p < 0.01; RR, 3.88), inadequate surgical margin (p < 0.01; RR, 2.42), and poor histologic response (p = 0.03; RR, 1.43) were independent poor prognostic factors of event-free survival. CONCLUSIONS Proximal tumor location and the presence of the fluid-fluid level on initial MRI were predictors of tumor progression and poor survival in patients presenting with Stage IIB osteosarcomas. If confirmed in other studies, patients with these risk factors should be considered for trials of other treatment strategy. LEVEL OF EVIDENCE Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Hansen AR, Hughes BG, Paul S, Steadman P, Sommerville S, Dickinson IC, Walpole ET, Thomson DB, Mar Fan HG, Joubert WL. Single institution retrospective review of perioperative chemotherapy in adult and adolescent patients with operable osteosarcoma. Asia Pac J Clin Oncol 2014; 12:e222-8. [PMID: 24571381 DOI: 10.1111/ajco.12167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2013] [Indexed: 11/29/2022]
Abstract
AIMS Perioperative chemotherapy has improved the prognosis for patients with operable osteosarcoma. The literature is conflicting about which regimen is optimal. The aim of this study was to evaluate the survival outcomes of two cohorts of patients with operable osteosarcoma treated with different perioperative chemotherapy regimens. METHODS This was a retrospective review of patients diagnosed with operable osteosarcoma treated at the Princess Alexandra Hospital from 1986 to 2009. The standard perioperative chemotherapy regimen changed from the modified T10 Rosen protocol to cisplatin/doxorubicin in 1997. Using the Kaplan-Meier method, overall survival (OS) and disease-free survival (DFS) curves were generated for the cisplatin/doxorubicin and the modified T10 Rosen cohorts. RESULTS Seventy-one patients were identified of whom 63 had potentially curable disease. Of these, 24 received the modified T10 Rosen regimen and 39 received cisplatin/doxorubicin. There was a non-significant trend toward better OS and DFS in the patients who received the modified T10 Rosen protocol. CONCLUSION The trend toward poorer survival in the cisplatin/doxorubicin cohort, in combination with current evidence, has prompted our institution to change its practice.
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Affiliation(s)
- Aaron R Hansen
- Division of Cancer Services, Princess Alexandra Hospital, Queensland, Australia
| | - Brett Gm Hughes
- Cancer Care Services, The Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Sanjoy Paul
- Queensland Clinical Trials and Biostatistics Centre, School of Population Health, The University of Queensland, Princess Alexandra Hospital, Queensland, Australia
| | - Peter Steadman
- Department of Orthopaedics, Princess Alexandra Hospital, Queensland, Australia
| | - Scott Sommerville
- Department of Orthopaedics, Princess Alexandra Hospital, Queensland, Australia
| | - Ian C Dickinson
- Department of Orthopaedics, Princess Alexandra Hospital, Queensland, Australia
| | - Euan T Walpole
- Division of Cancer Services, Princess Alexandra Hospital, Queensland, Australia
| | - Damien B Thomson
- Division of Cancer Services, Princess Alexandra Hospital, Queensland, Australia
| | - Helen G Mar Fan
- Division of Cancer Services, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Warren L Joubert
- Division of Cancer Services, Princess Alexandra Hospital, Queensland, Australia
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Miwa S, Takeuchi A, Ikeda H, Shirai T, Yamamoto N, Nishida H, Hayashi K, Tanzawa Y, Kimura H, Igarashi K, Tsuchiya H. Prognostic value of histological response to chemotherapy in osteosarcoma patients receiving tumor-bearing frozen autograft. PLoS One 2013; 8:e71362. [PMID: 23977028 PMCID: PMC3744566 DOI: 10.1371/journal.pone.0071362] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background A variety of surgical procedures are now available for tissue reconstruction after osteosarcoma excision, and an important prognostic factor is the evaluation of response to chemotherapy using histology. Although tumor-bearing autografts are useful tools for reconstruction, re-use of the primary tumor may make it difficult to assess the histological response to chemotherapy, since the entire tumor cannot be analyzed. Here, we analyzed the prognostic value of the histological response in the patients who received frozen tumor-bearing autografts for reconstruction. Method Retrospective analysis of the medical records of 51 patients with high-grade osteosarcoma of the extremities was performed. All patients received reconstruction using frozen tumor-bearing autografts. Tumor necrosis was evaluated in extraskeletal masses and cancellous bone. Results Five-year overall survival of patients with good and poor response to chemotherapy was 82.9% and 46.4%, respectively (P = 0.044), and 5-year event-free survival was 57.7% and 36.0%, respectively (P = 0.329). Multivariate analysis revealed that a poor histological response to chemotherapy was a significant prognostic factor for overall survival (P = 0.033). Conclusion Histological response is an important and reliable prognostic factor in patients undergoing reconstruction using frozen tumor-bearing autografts.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Akihiko Takeuchi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroko Ikeda
- Section of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Japan
| | - Toshiharu Shirai
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Norio Yamamoto
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hideji Nishida
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Yoshikazu Tanzawa
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Kentaro Igarashi
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University School of Medicine, Kanazawa, Japan
- * E-mail:
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Miller BJ, Cram P, Lynch CF, Buckwalter JA. Risk factors for metastatic disease at presentation with osteosarcoma: an analysis of the SEER database. J Bone Joint Surg Am 2013; 95:e89. [PMID: 23824394 PMCID: PMC3689260 DOI: 10.2106/jbjs.l.01189] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Osteosarcoma is the most common primary bone sarcoma and affects all ages. There are substantial differences in management and outcomes for patients who have localized disease compared with distant spread at the time of diagnosis. Our goal was to examine potential risk factors predictive of metastatic disease at presentation. METHODS The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify all patients diagnosed with osteosarcoma from 2000 to 2008 and to classify each patient as having metastatic or localized disease at the time of diagnosis. Patient-based characteristics, tumor characteristics, and county-level socioeconomic measures were analyzed to determine which factors were predictive of an increased rate of distant metastatic disease at presentation. These factors were analyzed as univariate characteristics as well as in a multivariate logistic regression model. RESULTS We identified 2017 cases of high-grade osteosarcoma, and 464 (23.0%) of the patients presented with metastatic disease. In the unadjusted logistic regression analysis, patients had increased odds of metastatic disease at presentation if they had an age of sixty years or more (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.71 to 2.89), had a tumor located in the axial skeleton (OR = 2.47; 95% CI, 1.88 to 3.26), and lived in a county with low socioeconomic status (OR = 1.59; 95% CI, 1.08 to 2.35). These factors remained significant when combined in multivariate models controlling for age, location, and socioeconomic status. For patients with recorded tumor size information (n = 1398), the odds of metastasis at presentation increased by 10% with each additional centimeter of tumor size (OR = 1.10; 95% CI, 1.08 to 1.13). When the patients with missing tumor size information were excluded, socioeconomic status was no longer a significant risk factor for metastasis at presentation in the multivariate model. CONCLUSIONS Osteosarcoma patients with advanced age, a tumor in the axial skeleton, a larger tumor size, and a residence in a less affluent county were more likely to have metastatic disease at presentation.
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Affiliation(s)
- Benjamin J. Miller
- Departments of Orthopaedics and Rehabilitation (B.J.M., J.A.B.), Internal Medicine (P.C.), and Epidemiology (C.F.L.), University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, Iowa 52242. E-mail address for B.J. Miller:
| | - Peter Cram
- Departments of Orthopaedics and Rehabilitation (B.J.M., J.A.B.), Internal Medicine (P.C.), and Epidemiology (C.F.L.), University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, Iowa 52242. E-mail address for B.J. Miller:
| | - Charles F. Lynch
- Departments of Orthopaedics and Rehabilitation (B.J.M., J.A.B.), Internal Medicine (P.C.), and Epidemiology (C.F.L.), University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, Iowa 52242. E-mail address for B.J. Miller:
| | - Joseph A. Buckwalter
- Departments of Orthopaedics and Rehabilitation (B.J.M., J.A.B.), Internal Medicine (P.C.), and Epidemiology (C.F.L.), University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, Iowa 52242. E-mail address for B.J. Miller:
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48
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Prognostic factors for teenage and adult patients with high-grade osteosarcoma: an analysis of 240 patients. Med Oncol 2013; 30:624. [PMID: 23749307 DOI: 10.1007/s12032-013-0624-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
Abstract
The aim of this retrospective, multicenter study was to evaluate clinicopathological characteristics, prognostic factors and treatment outcomes of teenage and adult patients with high-grade osteosarcoma. A total of 240 osteosarcoma patients who were diagnosed and treated from March 1995 to September 2011 were analyzed. Median age was 20 years (range 13-74 years), and 153 patients (63.8%) were male. Primary tumor localization was extremity in 204 patients (85.4 %), trunk in 21 patients (8.8%) and head and neck region in 14 patients (5.9%). According to American Joint Committee on Cancer staging system, 186 patients (77.5%) were stage II, 3 (1.3%) were stage III and 48 (20.0%) were stage IV. Median overall survival (OS) was 55 months (95 % CI 36.8-73.1 months). OS after 2, 5 and 10 years were 67, 49 and 42%, respectively. Univariable analysis for OS showed that male gender (p = 0.032), high baseline lactate dehydrogenase (LDH) level (p < 0.001), high baseline serum alkaline phosphatase level (p = 0.002), telangiectatic subtype (p = 0.023), presence of metastasis at diagnosis (p < 0.001), presence of tumor positive margins after primary surgery (p = 0.015), poor pathological response to preoperative chemotherapy (p = 0.006) and presence of recurrent disease during follow-up period (p < 0.001) were significantly associated with poor survival. Patients who received postoperative methotrexate plus doxorubicin plus cisplatin (M + A + P) combination regimen (p = 0.019), underwent surgery for recurrent disease (p < 0.001) and received chemotherapy for recurrent disease (p < 0.001) had longer OS. In multivariable analysis for OS, only high LDH level (p = 0.002) and the presence of metastasis at diagnosis (p = 0.011) were associated with poor OS, whereas the patients who received chemotherapy for recurrent disease had a longer OS (p = 0.009).
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49
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Abstract
Sarcomas are cancers arising from the mesenchymal layer that affect children, adolescents, young adults, and adults. Although most sarcomas are localized, many display a remarkable predilection for metastasis to the lungs, liver, bones, subcutaneous tissue, and lymph nodes. Additionally, many sarcoma patients presenting initially with localized disease may relapse at metastatic sites. While localized sarcomas can often be cured through surgery and often radiation, controversies exist over optimal management of patients with metastatic sarcoma. Combinations of chemotherapy are the most effective in many settings, and many promising new agents are under active investigation or are being explored in preclinical models. Metastatic sarcomas are excellent candidates for novel approaches with additional agents as they have demonstrated chemosensitivity and affect a portion of the population that is motivated toward curative therapy. In this paper, we provide an overview on the common sarcomas of childhood (rhabdomyosarcoma), adolescence, and young adults (osteosarcoma, Ewing sarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor) and older adults (leiomyosarcoma, liposarcoma, and undifferentiated high grade sarcoma) in terms of the epidemiology, current therapy, promising therapeutic directions and outcome with a focus on metastatic disease. Potential advances in terms of promising therapy and biologic insights may lead to more effective and safer therapies; however, more clinical trials and research are needed for patients with metastatic sarcoma.
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Affiliation(s)
- Ernest K Amankwah
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Anthony P Conley
- Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Damon R Reed
- Sarcoma Department, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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50
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Shin SH, Jeong HJ, Han I, Cho HS, Kim HS. Osteosarcoma and chondrosarcoma of the shoulder: site-specific comparative analysis. Orthopedics 2013; 36:e179-85. [PMID: 23380012 DOI: 10.3928/01477447-20130122-20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Osteosarcoma and chondrosarcoma compose most of the primary malignancies of the shoulder. The literature lacks site-specific comparative analyses of these 2 major shoulder sarcomas. The purposes of this study were to describe the different characteristics of the 2 major sarcomas near the glenohumeral joint, examine differences in treatment outcomes, and evaluate the functional outcomes of limb salvage surgery. Thirty-two patients with osteosarcoma or chondrosarcoma who underwent a wide resection including the glenohumeral joint were enrolled in this study. The characteristics of tumor development and treatment, oncologic and functional outcomes, and factors affecting outcomes were compared between groups and with the literature. The results showed shoulder osteosarcoma developing similarly to the literature reports, whereas chondrosarcoma tended to be of a high histologic grade. Nonetheless, the osteosarcoma group had a poorer overall 5-year survival rate (53.0%) than the chondrosarcoma group (85.7%) or those in previous reports. The osteosarcoma group had a tendency toward a worse 5-year metastasis-free survival rate than the chondrosarcoma group (35.4% vs 75.0%, respectively), although the 5-year local recurrence-free survival rate was not significantly different between the 2 groups (75.0% vs 87.5%, respectively). Histologic grade, surgical stage, and chemotherapy affected the oncologic outcomes in univariate analysis, although not a single factor was independent in multivariate analysis. The functional outcomes were not significantly affected by clinical characteristics or surgical methods in patients who had undergone a wide resection including the glenohumeral joint.
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Affiliation(s)
- Seung Han Shin
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
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