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Mettmann VL, Blattmann C, Friedel G, Harrabi S, von Kalle T, Kager L, Kevric M, Kühne T, Nathrath M, Sorg B, Werner M, Bielack SS, Hecker-Nolting S. Primary Multi-Systemic Metastases in Osteosarcoma: Presentation, Treatment, and Survival of 83 Patients of the Cooperative Osteosarcoma Study Group. Cancers (Basel) 2024; 16:275. [PMID: 38254767 PMCID: PMC10813782 DOI: 10.3390/cancers16020275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND To evaluate patient and tumour characteristics, treatment, and their impact on survival in patients with multi-systemic metastases at initial diagnosis of high-grade osteosarcoma. Precedure: Eighty-three consecutive patients who presented with multi-systemic metastases at initial diagnosis of high-grade osteosarcoma were retrospectively reviewed. In cases of curative intent, the Cooperative Osteosarcoma Study Group recommended surgical removal of all detectable metastases in addition to complete resection of the primary tumour and chemotherapy. RESULTS Eighty-three eligible patients (1.8%) were identified among a total of 4605 individuals with high-grade osteosarcoma. Nine (10.8%) of these achieved complete surgical remission, of whom seven later had recurrences. The median follow-up time was 12 (range, 1-165) months for all patients. Actuarial event-free survival after 1, 2, and 5 years was 9.6 ± 3.2%, 1.4 ± 1.4%, and 1.4 ± 1.4%, and overall survival was 54.0 ± 5.6%, 23.2 ± 4.9%, and 8.7 ± 3.3%. In univariate analyses, elevated alkaline phosphatase before chemotherapy, pleural effusion, distant bones as metastatic sites, and more than one bone metastasis were negative prognostic factors. Among treatment-related factors, the microscopically complete resection of the primary tumour, a good response to first-line chemotherapy, the macroscopically complete resection of all affected tumour sites, and local treatment (surgery ± radiotherapy) of all bone metastases were associated with better outcomes. Tumour progression under first-line treatment significantly correlated with shorter survival times. CONCLUSION The outlook for patients with multi-systemic primary metastases from osteosarcoma remains very poor. The utmost importance of surgical resection of all tumour sites was confirmed. For unresectable bone metastases, radiotherapy might be considered. In the patient group studied, standard chemotherapy was often insufficiently effective. In the case of such advanced disease, alternative treatment options are urgently required.
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Affiliation(s)
- Vanessa L. Mettmann
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Claudia Blattmann
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Godehard Friedel
- Department of Thoracic Surgery, Faculty of Science, University of Tubingen, 72076 Tubingen, Germany
| | - Semi Harrabi
- Heidelberg Ion Beam Therapy Centre (HIT), Department of Radiation Oncology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Thekla von Kalle
- Radiologic Institute, Centre for Paediatric, Adolescent and Women’s Medicine, Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Leo Kager
- St. Anna Children’s Hospital, University Hospital for Paediatric and Adolescent Medicine of the Medical University and St. Anna Children’s Cancer Research Institute (CCRI), 1090 Vienna, Austria
| | - Matthias Kevric
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Thomas Kühne
- University Children’s Hospital Basel, 4031 Basel, Switzerland
| | - Michaela Nathrath
- Department of Paediatrics and Children’s Cancer Research Centre, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
- Paediatric Haematology and Oncology, Klinikum Kassel, 34125 Kassel, Germany
| | - Benjamin Sorg
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
| | - Mathias Werner
- Osteopathology Reference Centre, Institute of Pathology, Vivantes Klinikum im Friedrichshein, 10249 Berlin, Germany
| | - Stefan S. Bielack
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
- Department for Paediatric Haematology and Oncology, University’s Children’s Hospital Muenster, 48149 Muenster, Germany
| | - Stefanie Hecker-Nolting
- Cooperative Osteosarcoma Study Group, Paediatrics 5 (Oncology, Haematology, Immunology), Centre for Paediatric, Adolescent and Women’s Medicine, and Stuttgart Cancer Centre, Klinikum Stuttgart–Olgahospital, 70174 Stuttgart, Germany
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Goulding D, Arguinchona L, Anderson-Mellies A, Mikkelsen M, Eguchi M, Marinoff H, Zahedi S, Ribeiro KB, Cockburn M, Galindo CR, Green AL. Sociodemographic Disparities in Presentation and Survival of Pediatric Bone Cancers. J Pediatr Hematol Oncol 2023; 45:e31-e43. [PMID: 36044295 PMCID: PMC9812857 DOI: 10.1097/mph.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/09/2022] [Indexed: 02/03/2023]
Abstract
Osteosarcoma (OST) and Ewing sarcoma (ES) are the most common pediatric bone cancers. Patients with metastatic disease at diagnosis have poorer outcomes compared with localized disease. Using the Surveillance, Epidemiology, and End Results registries, we identified children and adolescents diagnosed with OST or ES between 2004 and 2015. We examined whether demographic and socioeconomic disparities were associated with a higher likelihood of metastatic disease at diagnosis and poor survival outcomes. In OST, Hispanic patients and those living in areas of high language isolation were more likely to have metastatic disease at diagnosis. Regardless of metastatic status, OST patients with public insurance had increased odds of death compared to those with private insurance. Living in counties with lower education levels increased odds of death for adolescents with metastatic disease. In ES, non-White adolescents had higher odds of death compared with white patients. Adolescents with metastatic ES living in higher poverty areas had increased odds of death compared with those living in less impoverished areas. Disparities in both diagnostic and survival outcomes based on race, ethnicity, and socioeconomic factors exist in pediatric bone cancers, potentially due to barriers to care and treatment inequities.
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Affiliation(s)
- DeLayna Goulding
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Lauren Arguinchona
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | - Margit Mikkelsen
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Megan Eguchi
- Center of Biostatistics, University of Colorado School of Medicine, Aurora, CO
| | - Hannah Marinoff
- Center of Biostatistics, University of Colorado School of Medicine, Aurora, CO
| | - Shadi Zahedi
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | | | - Myles Cockburn
- Center of Biostatistics, University of Colorado School of Medicine, Aurora, CO
| | | | - Adam L. Green
- Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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An External-Validated Prediction Model to Predict Lung Metastasis among Osteosarcoma: A Multicenter Analysis Based on Machine Learning. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2220527. [PMID: 35571720 PMCID: PMC9106476 DOI: 10.1155/2022/2220527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/07/2022] [Accepted: 04/09/2022] [Indexed: 01/05/2023]
Abstract
Background Lung metastasis greatly affects medical therapeutic strategies in osteosarcoma. This study aimed to develop and validate a clinical prediction model to predict the risk of lung metastasis among osteosarcoma patients based on machine learning (ML) algorithms. Methods We retrospectively collected osteosarcoma patients from the Surveillance Epidemiology and End Results (SEER) database and from four hospitals in China. Six ML algorithms, including logistic regression (LR), gradient boosting machine (GBM), extreme gradient boosting (XGBoost), random forest (RF), decision tree (DT), and multilayer perceptron (MLP), were applied to build predictive models for predicting lung metastasis using patient's demographics, clinical characteristics, and therapeutic variables from the SEER database. The model was internally validated using 10-fold cross-validation to calculate the mean area under the curve (AUC) and the model was externally validated using the Chinese multicenter osteosarcoma data. Relative importance ranking of predictors was plotted to understand the importance of each predictor in different ML algorithms. The correlation heat map of predictors was plotted to understand the correlation of each predictor, selecting the 10-fold cross-validation with the highest AUC value in the external validation ROC curve to build a web calculator. Results Of all enrolled patients from the SEER database, 17.73% (194/1094) developed lung metastasis. The multiple logistic regression analysis showed that sex, N stage, T stage, surgery, and bone metastasis were all independent risk factors for lung metastasis. In predicting lung metastasis, the mean AUCs of the six ML algorithms ranged from 0.711 to 0.738 in internal validation and 0.697 to 0.729 in external validation. Among the six ML algorithms, the extreme gradient boosting (XGBoost) model had the highest AUC value with an average internal AUC of 0.738 and an external AUC of 0.729. The best performing ML algorithm model was used to build a web calculator to facilitate clinicians to calculate the risk of lung metastasis for each patient. Conclusions The XGBoost model may have the best prediction effect and the online calculator based on this model can help doctors to determine the lung metastasis risk of osteosarcoma patients and help to make individualized medical strategies.
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Soomers V, Husson O, Young R, Desar I, Van der Graaf W. The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes. ESMO Open 2021; 5:S2059-7029(20)30008-9. [PMID: 32079621 PMCID: PMC7046415 DOI: 10.1136/esmoopen-2019-000592] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 12/27/2022] Open
Abstract
Sarcomas are rare and heterogeneous mesenchymal tumours of soft tissue or bone, making them prone to late diagnosis. In other malignancies, early diagnosis has an impact on stage of disease, complexity of therapeutic procedures, survival and health-related quality of life (HRQoL). Little is known about what length of diagnostic interval should be considered as delay in patients with bone (BS) or soft tissue sarcomas (STS). To quantify total interval (defined as time from first symptom to histological diagnosis) and its components, identify contributing factors to its length and determine the impact on patients’ outcome in terms of mortality and HRQoL. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-six articles out of 2310 met the predefined inclusion criteria. Total intervals, varied broadly; 9–120.4 weeks for BS and 4.3–614.9 weeks for STS. Older age and no initial radiological examinations were contributing factors for a long interval in BS, while in STS results were conflicting. The impact of length of total interval on clinical outcomes in terms of survival and morbidity remains ambiguous; no clear relation could be identified for both BS and STS. No study examined the impact on HRQoL. The length of total interval is variable in BS as well as STS. Its effect on outcomes is contradictory. There is no definition of a clinically relevant cut-off point that discriminates between a short or long total interval. Prospero: CRD42017062492.
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Affiliation(s)
- Vicky Soomers
- Medical Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Olga Husson
- Institute of Cancer Research, London, London, UK.,Psychosocial research and epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Robin Young
- Medical Oncology, Weston Park Hospital, Sheffield, Sheffield, UK
| | - Ingrid Desar
- Medical Oncology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Winette Van der Graaf
- Medical Oncology, Antoni van Leewenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.,Medical Oncology, Radboudumc, Nijmegen, The Netherlands
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5
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Yoshida S, Celaire J, Pace C, Taylor C, Kaneuchi Y, Evans S, Abudu A. Delay in diagnosis of primary osteosarcoma of bone in children: Have we improved in the last 15 years and what is the impact of delay on diagnosis? J Bone Oncol 2021; 28:100359. [PMID: 33898215 PMCID: PMC8056435 DOI: 10.1016/j.jbo.2021.100359] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/05/2021] [Accepted: 03/23/2021] [Indexed: 11/27/2022] Open
Abstract
Aims Examine: (1) If length of symptoms (LS) of children with osteosarcoma has improved in the last 15 years (2) Is delay in diagnosis related to the presence of metastases at presentation? (3) The impact of delay in diagnosis on prognosis. Methods 250 consecutive patients with a diagnosis of osteosarcoma of bone treated at a national bone tumor treatment center between 2004 and 2018 were studied retrospectively. Three groups comprising those diagnosed over a five-year period (Group 1: 2004-2008, Group 2: 2009-2013; Group 3: 2014-2018) were studied. Results There were 126 males and 124 females with a mean age 12.2 years. The median LS for all patients was eight weeks. The median LS for Group 3 was significantly shorter than that for other groups. Development of metastasis during follow-up period was significantly less in Group 3 compared to the other groups. Overall survival gradually improved over the whole study period. There was no difference in the proportion presenting with metastases at diagnosis between the three groups. The survival rates in patients with LS shorter than 4 weeks was better than those with LS longer than 4 weeks, irrespective of the study time period. Conclusions There has been an improvement in the LS in patients diagnosed with osteosarcoma over the last 15 years. The development of metastasis during follow-up has reduced and the overall survival in the last 15 years has improved. LS longer than 4 weeks is associated with a poorer prognosis.
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Affiliation(s)
- Shinichirou Yoshida
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK.,Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - James Celaire
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK
| | - Chloe Pace
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK
| | - Charles Taylor
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK
| | - Yoichi Kaneuchi
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK.,Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, Japan 1, Hikarigaoka, Fukushima 960-1295, Japan
| | - Scott Evans
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK
| | - Adesegun Abudu
- The Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, Birmingham, UK
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6
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-332. [PMID: 33252328 PMCID: PMC7768788 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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Diessner BJ, Weigel BJ, Murugan P, Zhang L, Poynter JN, Spector LG. Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis. JAMA Netw Open 2020; 3:e2011087. [PMID: 32766799 PMCID: PMC7414392 DOI: 10.1001/jamanetworkopen.2020.11087] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Approximately 10% to 30% of patients with sarcoma present with detectable metastases at diagnosis. However, the extent to which presentation with metastases is due to delayed diagnosis vs other factors remains unclear. OBJECTIVE To evaluate whether socioeconomic status, insurance status, or race/ethnicity were associated with the presence of metastases at diagnosis of sarcoma. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the population-based Surveillance, Epidemiology, and End Results program. Adult and pediatric patients with an initial diagnosis of soft-tissue and bone sarcoma between 2001 and 2015 were stratified by age group (pediatric, <20 years; adult, 20-65 years; older adult, >65 years) and sarcoma subtype. Statistical analyses were performed between August 2019 and January 2020. EXPOSURES Surveillance, Epidemiology, and End Results Census tract-level socioeconomic status index, insurance status, and race/ethnicity. MAIN OUTCOMES AND MEASURES The odds of presenting with metastases at diagnosis were calculated. RESULTS A total of 47 337 patients with first primary malignant sarcoma were included (24 343 male patients [51.4%]), with 29 975 non-Hispanic White patients (63.3%), 5673 non-Hispanic Black patients (12.0%), 7504 Hispanic patients (15.8%), and 4185 American Indian-Alaskan Native and Asian Pacific Islander patients (8.8%). Liposarcoma in adults was the only subtype and age group combination that demonstrated a significant trend in incidence across socioeconomic status levels (odds ratio, 0.85; 99% CI, 0.76-0.96; P = .001). However, compared with having non-Medicaid insurance, having Medicaid or no insurance in adults was associated with an increased odds of metastases at diagnosis for 6 of the 8 sarcoma subtypes evaluated; osteosarcoma and Ewing sarcoma were the only 2 subtypes in adults for which metastases were not associated with insurance status. In addition, there was an increased risk of presenting with metastases among non-Hispanic Black adults diagnosed with leiomyosarcoma (odds ratio, 1.87; 99% CI, 1.41-2.48) and unclassified sarcomas (odds ratio, 1.65; 99% CI, 1.01-2.67) compared with non-Hispanic White adults that was independent of socioeconomic and insurance status. CONCLUSIONS AND RELEVANCE These findings suggest that delayed access to care is associated with advanced stage at diagnosis for several soft-tissue sarcoma subtypes in adults, whereas other factors may be associated with the metastatic progression of osteosarcoma and Ewing sarcoma, as well as the racial disparities observed with metastatic leiomyosarcoma and unclassified sarcomas.
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Affiliation(s)
- Brandon J. Diessner
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Brenda J. Weigel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis
| | - Lin Zhang
- Division of Biostatistics, University of Minnesota, Minneapolis
| | - Jenny N. Poynter
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis
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Jiang Y, Wang T, Wei Z. Construction and Validation of Nomograms for Predicting the Prognosis of Juvenile Osteosarcoma: A Real-World Analysis in the SEER Database. Technol Cancer Res Treat 2020; 19:1533033820947718. [PMID: 33054584 PMCID: PMC7570778 DOI: 10.1177/1533033820947718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Osteosarcoma is one of the most common malignant bone tumors, with a high incidence in adolescence. The objective of this study was to construct prognostic nomograms for predicting the prognosis of juvenile osteosarcoma. METHODS Patients with osteosarcoma diagnosed between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The essential clinical predictors were identified with univariate and multivariate Cox analysis. Nomograms were constructed to predict the 3- and 5-year cancer- specific survival (CSS) and overall survival (OS). Concordance index (C-index) and calibration plots were performed to validate the predictive performance of nomograms. RESULTS We enrolled 736 adolescents with osteosarcoma from the SEER database, with 516 samples grouped into a training cohort and 220 samples grouped into a validation cohort. In multivariate analysis of the training cohort, predictors including tumor size, surgery treatment and AJCC stage were found to be associated with OS and CSS, while age was only associated with CSS. Construction of nomograms based on these predictors was performed to evaluate the prognosis of adolescents with osteosarcoma. The C-index and calibration curves also showed the satisfactory performance of these nomograms for prognosis prediction. CONCLUSION The developed nomograms are useful tools for precisely predicting the prognosis of adolescents with osteosarcoma, which could enable patients to be more accurately managed in clinical practice.
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Affiliation(s)
- Yao Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianyu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zizheng Wei
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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9
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Ali N, Venkateswaran G, Garcia E, Landry T, McColl H, Sergi C, Persad A, Abuetabh Y, Eisenstat DD, Persad S. Osteosarcoma progression is associated with increased nuclear levels and transcriptional activity of activated β-Catenin. Genes Cancer 2019; 10:63-79. [PMID: 31258833 PMCID: PMC6584208 DOI: 10.18632/genesandcancer.191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Osteosarcoma (OS) is an aggressive primary bone malignancy that has peak incidence in children and young adults <25 years of age. Despite current multimodal treatments, no significant change in patient outcome has been observed in two decades. Presently, there is a lack of established, reliable baseline prognostic markers for aggressive OS, other than extent and site of disease involvement. The canonical Wnt/β-catenin pathway controls multiple cellular processes, and is known to be a critical pathway in OS progression. This pathway regulates cellular levels of β-catenin, which is a significant player in the oncogenesis and progression of many cancers. We investigated the relationship between β-catenin, more specifically, the transcriptionally active form of β-catenin, Activated β-Catenin (ABC), and OS progression. Using an in vitro model, we observed that cellular/nuclear ABC levels, but not cellular/nuclear β-catenin levels, increase with the degree of aggressiveness in OS. Our results demonstrate a strong association between nuclear-ABC levels and aggressive OS in vitro. Furthermore, we observed significant correlation between positive nuclear-ABC and patient age and tumor stage. Our results support the potential use of ABC as a predictive marker for risk stratification in OS.
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Affiliation(s)
- Noureen Ali
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Elizabeth Garcia
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Takaaki Landry
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Hunter McColl
- Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada
| | - Consolato Sergi
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Amit Persad
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Yasser Abuetabh
- Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - David D Eisenstat
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Medical Genetics, University of Alberta, Edmonton, Alberta, Canada.,Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Sujata Persad
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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Lawrenz JM, Styron JF, Parry M, Grimer RJ, Mesko NW. Longer duration of symptoms at the time of presentation is not associated with worse survival in primary bone sarcoma. Bone Joint J 2018; 100-B:652-661. [PMID: 29701086 DOI: 10.1302/0301-620x.100b5.bjj-2017-1235.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims The primary aim of this study was to determine the effect of the duration of symptoms (DOS) prior to diagnosis on the overall survival in patients with a primary bone sarcoma. Patients and Methods In a retrospective analysis of a sarcoma database at a single institution between 1990 and 2014, we identified 1446 patients with non-metastatic and 346 with metastatic bone sarcoma. Low-grade types of tumour were excluded. Our data included the demographics of the patients, the characteristics of the tumour, and the survival outcome of patients. Cox proportional hazards analysis and Kaplan-Meier survival analysis were performed, and the survivorship of the non-metastatic and metastatic cohorts were compared. Results In the non-metastatic cohort, a longer DOS was associated with a slightly more favourable survival (hazard ratio (HR) 0.996, 95% confidence interval (CI) 0.994 to 0.998, p < 0.001). In all types of tumour, there was no difference in survival between patients with a DOS of greater than four months and those with a DOS of less than four months (p = 0.566). There was no correlation between the year of diagnosis and survival (p = 0.741). A diagnosis of chondrosarcoma (HR 0.636, 95% CI 0.474 to 0.854, p = 0.003) had the strongest positive effect on survival, while location in the axial skeleton (HR 1.76, 95% CI 1.36 to 2.29, p < 0.001) had the strongest negative effect on survival. Larger size of tumour (HR 1.05, 95% CI 1.03 to 1.06, p < 0.001) and increased age of the patient (HR 1.02, 95% CI 1.01 to 1.03, p < 0.001) had a slightly negative effect on survival. Metastatic and non-metastatic cohorts had similar median DOS (16 weeks, p = 0.277), although the median survival (15.5 months vs 41 months) and rates of survival at one year (69% vs 89%) and five years (20% vs 59%) were significantly shorter in the metastatic cohort. Conclusion A longer DOS prior to diagnosis is not associated with a poorer overall survival in patients with a primary bone sarcoma. Location in the axial skeleton remains the strongest predictor of a worse prognosis. This may be helpful in counselling patients referred for evaluation on a delayed basis. Cite this article: Bone Joint J 2018;100-B:652-61.
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Affiliation(s)
- J M Lawrenz
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - J F Styron
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - M Parry
- Orthopaedic Oncology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - R J Grimer
- Orthopaedic Oncology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - N W Mesko
- Center Director, Musculoskeletal Oncology, Director of Sarcoma Care, Cleveland Clinic Foundation and Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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11
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Oi T, Asanuma K, Matsumine A, Matsubara T, Nakamura T, Iino T, Asanuma Y, Goto M, Okuno K, Kakimoto T, Yada Y, Sudo A. STAT3 inhibitor, cucurbitacin I, is a novel therapeutic agent for osteosarcoma. Int J Oncol 2016; 49:2275-2284. [PMID: 27840900 PMCID: PMC5117998 DOI: 10.3892/ijo.2016.3757] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 10/06/2016] [Indexed: 12/03/2022] Open
Abstract
The development of clinical agents remains a costly and time-consuming process. Although identification of new uses of existing drugs has been recognized as a more efficient approach for drug discovery than development of novel drugs, little screening of drugs that might be used for a rare malignant tumor such as osteosarcoma (OS) has been performed. In this study, we attempted to identify new molecular targeted agents for OS by employing Screening Committee of Anticancer Drugs (SCADS) kits. To screen compounds for OS treatment, their effect on cell viability of the OS cell lines 143B, MG63, HOS, SAOS-2, and HUO9 were evaluated. Candidate drugs were narrowed down based on a global anti-proliferative effect against these five OS cell lines. After excluding cytotoxic compounds and compounds unsuitable for in vivo administration, cucurbitacin I was extracted. Cucurbitacin I has been found to have cytotoxic and anti-proliferative properties against several tumors through inhibition of signal transducer and activator of transcription 3 (STAT3) activation. Cucurbitacin I dose- and time-dependently inhibited the proliferation of all five OS cell lines. Following cucurbitacin I treatment, STAT3 was inactivated and analysis of Mcl-1, cleaved PARP and caspase-3 indicated apoptosis induction. Expression of cell cycle regulator proteins, such as phospho-cyclin D1, c-Myc and survivin, were suppressed. Finally, cucurbitacin I potently inhibited the tumor growth of human OS 143B cells in nude mice. Our in vitro and in vivo results suggest that STAT3 inhibition by cucurbitacin I will be an effective and new approach for the treatment of OS.
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Affiliation(s)
- Toru Oi
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Akihiko Matsumine
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Takao Matsubara
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Takahiro Iino
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yumiko Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Mikinobu Goto
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Kazuma Okuno
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Takuya Kakimoto
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Yuki Yada
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Mie 514-8507, Japan
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12
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Hendershot E, Pappo A, Malkin D, Sung L. Tumor Necrosis in Pediatric Osteosarcoma: Impact of Modern Therapies. J Pediatr Oncol Nurs 2016; 23:176-81. [PMID: 16766682 DOI: 10.1177/1043454206289786] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tumor necrosis following preoperative chemotherapy in patients with osteosarcoma is a predictor of overall survival. With modern therapies, 45% of patients are expected to achieve more than 90% tumor necrosis. Investigators at the authors’ center, however, increasingly noted that patients were experiencing inferior necrosis responses. A retrospective study of treated patients at the center was undertaken to examine this. The purpose of this study was to determine (1) whether the number of patients with favorable histological responses had changed over time and (2) whether the percentage of patients with favorable responses was similar to published outcomes. Chart reviews were performed on patients treated from 1993 to 2003 according to the Pediatric Oncology Group 9351, regimen A protocol. Twenty-one patients met all eligibility requirements; 52% of patients had more than 90% necrosis. No correlation existed between degree of necrosis and year of treatment (r = 0.06; P = .8). Patients with osteosarcoma treated at the authors’ institution have comparable tumor necrosis responses to published outcomes, and no change occurred over time. This study stresses the importance of rigorous retrospective reviews before implementing treatment changes.
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Affiliation(s)
- Eleanor Hendershot
- Division of Hematology/Oncology, Hospital for Sick Children in Toronto, Ontario, Canada.
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13
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Marko TA, Diessner BJ, Spector LG. Prevalence of Metastasis at Diagnosis of Osteosarcoma: An International Comparison. Pediatr Blood Cancer 2016; 63:1006-11. [PMID: 26929018 PMCID: PMC4833631 DOI: 10.1002/pbc.25963] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/04/2016] [Accepted: 02/07/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Osteosarcoma (OS) is the most common primary malignant bone tumor in many countries, with metastatic disease responsible for most patient deaths. This study compares the prevalence of metastatic OS at diagnosis across countries to inform the critical question of whether diagnostic delay or tumor biology drives metastases development prior to diagnosis. PROCEDURE A literature search of the PubMed database was conducted to compare the prevalence of metastatic disease at the time of OS diagnosis between countries. A pooled prevalence with 95% confidence intervals was calculated for each study meeting inclusion criteria. Studies were grouped for analysis based on human development index (HDI) scores. RESULTS Our analysis found an 18% (95% confidence interval [CI]: 15%, 20%) average global pooled proportion of metastasis at OS diagnosis. The average prevalence of metastasis at diagnosis increased as HDI groupings decreased, with very high HDI, high HDI, and medium/low HDI groups found to be 15% (95% CI: 13%, 17%), 20% (95% CI: 14%, 28%), and 31% (95% CI: 15%, 52%), respectively. CONCLUSIONS Our evidence suggests there is a biological baseline for metastatic OS at diagnosis, which is observed in countries with very high HDI. In countries with medium/low HDI, where there are more barriers to accessing healthcare, the higher prevalence of metastasis may result from treatment delay or an artificial prevalence inflation due to patients with less severe symptoms not presenting to clinic. Additional research in countries with medium/low HDI may reveal that earlier detection and treatment could improve patient outcomes in those countries.
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Affiliation(s)
| | | | - Logan G. Spector
- Department of Pediatric Epidemiology, University of Minnesota,Corresponding Author: 420 Delaware Street, SE, MMC 715, Minneapolis, MN 55455, , phone: 612-624-3912, fax: 612-624-7147
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14
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Marais LC, Bertie J, Rodseth R, Sartorius B, Ferreira N. Pre-treatment serum lactate dehydrogenase and alkaline phosphatase as predictors of metastases in extremity osteosarcoma. J Bone Oncol 2015; 4:80-4. [PMID: 26587373 PMCID: PMC4648997 DOI: 10.1016/j.jbo.2015.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/01/2015] [Accepted: 09/24/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The prognosis of patients with metastatic osteosarcoma remains poor. However, the chance of survival can be improved by surgical resection of all metastases. In this study we investigate the value of serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in predicting the presence of metastatic disease at time of diagnosis. METHODS Sixty-one patients with histologically confirmed conventional osteosarcoma of the extremity were included in the study. Only 19.7% of cases presented without evidence of systemic spread of the disease. Pre-treatment serum ALP and LDH were analysed in patients with and without skeletal or pulmonary metastases. RESULTS Serum LDH and ALP levels were not significantly different in patients with or without pulmonary metastases (p=0.88 and p=0.47, respectively). The serum LDH and ALP levels did however differ significantly in patients with or without skeletal metastases (p<0.001 and p=0.02, respectively). The optimal breakpoint for serum LDH as a marker of skeletal metastases was 849 IU/L (AUC 0.839; Sensitivity=0.88; Specificity=0.73). LDH >454 IU/L equated to 100% sensitivity for detected bone metastases (positive diagnostic likelihood ratio (DLR)=1.32). With a cut-off of 76 IU/L a sensitivity of 100% was reached for serum ALP predicting the presence of skeletal metastases (positive DLR=1.1). In a multivariate analysis both LDH ≥850 IU/L (odds ratio [OR]=9; 95% confidence interval (CI) 1.8-44.3) and ALP ≥280 IU/L (OR=10.3; 95% CI 2.1-50.5) were predictive of skeletal metastases. LDH however lost its significance in a multivariate model which included pre-treatment tumour volume. CONCLUSION In cases of osteosarcoma with LDH >850 IU/L and/or ALP >280 IU/L it may be prudent to consider more sensitive staging investigations for detection of skeletal metastases. Further research is required to determine the value and the most sensitive cut-off points of serum ALP and LDH in the prediction of skeletal metastases.
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Key Words
- ALP, alkaline phosphatase
- AUC, area under curve
- Alkaline phosphatase
- CI, confidence interval
- CT, computed tomography
- DLR, diagnostic likelihood ratio
- ESMO, European Society of Medical Oncology
- FDG-PET, 18F-fluorodeoxy-D-glucose positron emission tomography
- LDH, lactate dehydrogenase
- Lactate dehydrogenase
- MRI, magnetic resonance imaging
- Metastases
- OR, odds ratio
- Osteosarcoma
- Prognosis
- ROC, Receiver operating characteristic
- SD, standard deviation
- SEER, Surveilance, Epidemiology and End Results
- Staging
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Affiliation(s)
- Leonard C Marais
- Tumor, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - Julia Bertie
- Department of Orthopaedic Surgery, Edendale Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - Reitze Rodseth
- Perioperative Research Group, Department of Anaesthetics, Grey's Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
| | - Benn Sartorius
- Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Nando Ferreira
- Tumor, Sepsis and Reconstruction Unit, Department of Orthopaedic Surgery, Greys Hospital, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
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15
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 638] [Impact Index Per Article: 70.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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16
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Prognostic factors and treatment results of high-grade osteosarcoma in norway: a scope beyond the "classical" patient. Sarcoma 2015; 2015:516843. [PMID: 25784831 PMCID: PMC4346701 DOI: 10.1155/2015/516843] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/12/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. A retrospective study of prognostic factors and treatment outcome of osteosarcoma (OS) during modern chemotherapy era with focus on patients with primary metastatic disease, nonextremity localisation, or age >40 years (nonclassical OS). Methods. A nationwide cohort, comprising 424 high-grade Norwegian bone OS patients, was based on registry sources supplemented with clinical records from hospitals involved in sarcoma management between 1975 and 2009. Results. Only 48% were younger patients with tumour in the extremities and without metastasis at diagnosis (classical OS). A considerable discrepancy in survival between classical and nonclassical OS was observed: 61% versus 26% 10-year sarcoma specific survival. Twice as many of the former received both adequate surgery and chemotherapy compared to the latter. This could only partly explain the differences in survival due to inherent chemoresistance in primary metastatic disease and a higher rate of local relapse among patients with axial tumours. Metastasis at diagnosis, increased lactate dehydrogenase, age > 40 years, and tumour size above median value were all adverse prognostic factors for overall survival. Conclusion. We confirm a dramatic difference in outcome between classical and nonclassical high-grade OS patients, but treatment variables could only partly explain the dismal outcome of the latter.
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17
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Berner K, Johannesen TB, Berner A, Haugland HK, Bjerkehagen B, B⊘hler PJ, Bruland ØS. Time-trends on incidence and survival in a nationwide and unselected cohort of patients with skeletal osteosarcoma. Acta Oncol 2015; 54:25-33. [PMID: 24957555 PMCID: PMC4364276 DOI: 10.3109/0284186x.2014.923934] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background This study describes time-trends on epidemiology, subtypes and histopathological entities of osteosarcoma (OS) in a nationwide and unselected cohort of OS patients in Norway between 1975 and 2009. Few nationwide studies are published, and we still have particularly limited knowledge regarding patients not included in clinical trials comprising about half of the OS population. Method Histologically verified skeletal OS for all subgroups were included, resulting in 473 eligible cases from a total of 702 evaluated patients. To ensure completeness, the present cohort was based on all cases reported to the Norwegian Cancer Registry, complemented with data from all Norwegian hospitals involved in sarcoma management. Survival analyses were performed with overall and sarcoma-specific survival as endpoints. Results Mean annual age-standard incidence amounted to about 3.8 per million in male and 2.8 per million in female with no clear time-trends. The male to female ratio was 1.4. Peak incidence was observed in the second decade for both genders. Conventional OS comprised 71.2% of all cases, while low grade OS represented 10.4% and telangiectatic OS only 1.3%. The most common primary site of OS was femur and tibia, respectively. The axial to appendicular ratio increased with the age. The overall 10-year survival did increase from about 30% during the late 1970s to around 50% 20 years later, with no subsequent improvement during the last two decades. Axial tumours, age above 40 years and overt metastatic disease at time of diagnosis were all negative prognostic factors. Conclusion No improvement in the overall survival for OS since the 1990s was documented. The survival rates are still poor for elderly people, patients with axial disease and in the primary metastatic setting. The average incidence rate of skeletal OS in Norway was in line with international figures.
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Affiliation(s)
- Kjetil Berner
- Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
- The Norwegian Cancer Registry, Oslo, Norway
- Correspondence: K. Berner, Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, PO Box 4953, Nydalen, 0424 Oslo, Norway. Tel: +47 22934000. Fax: +47 22525559. E-mail:
| | | | - Aasmund Berner
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Bodil Bjerkehagen
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Per J. B⊘hler
- Department of Pathology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
| | - Øyvind S. Bruland
- Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Abdelkhalek E, Sherief L, Kamal N, Soliman R. Factors associated with delayed cancer diagnosis in egyptian children. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2014; 8:39-44. [PMID: 25232287 PMCID: PMC4159362 DOI: 10.4137/cmped.s16413] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/14/2014] [Accepted: 07/16/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite tremendous importance of early cancer diagnosis in children, few studies on this topic have been conducted in Egypt. Early stage diagnosis can have a positive effect on prognoses and the quality of life of children with cancer. We investigated delays in the diagnosis of childhood cancers in Egypt and determined the factors associated with these delays. METHODS This retrospective study included 172 children with cancer from two pediatric oncology units. The interval between symptoms onset and final diagnosis for each child was estimated and examined by univariate and multivariate analyses to determine correlations with the child’s sex, age at diagnosis, type and site of malignancy, family residence, socioeconomic status, and parental educational level. FINDINGS The median total diagnosis delay period was 47 days caused by patients and/or parents (8 days) and diagnosis (28 days). Statistically significant patient factors associated with delayed diagnosis were age (<5 years), lower parental education, and socioeconomic status. Sex residence and family size were not significant. Malignancy type and tumor site significantly affected the time for diagnosis. The lowest median value was associated with germ cell tumors (GCTs) and leukemia, and the highest value was in children with brain tumor. Missed diagnoses were initially recorded in 39.5% of the patients and were associated with patient and tumor factors. INTERPRETATION Delayed diagnosis of childhood cancer is related to age, family, socioeconomic status and parental education, and cancer type and site. Efforts should be made to promote awareness, develop effective steps to eliminate possible contributing factors, and determine the best intervention method.
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Affiliation(s)
- Er Abdelkhalek
- Pediatric Department, Faculty of Medicine, Zagazig University, Egypt. ; Pediatric Department, Banha Children's Hospital, Egypt
| | - Lm Sherief
- Pediatric Department, Faculty of Medicine, Zagazig University, Egypt. ; Pediatric Department, Banha Children's Hospital, Egypt
| | - Nm Kamal
- Pediatric Department, Faculty of Medicine, Cairo University, Egypt
| | - Rm Soliman
- Clinical Research Specialist, Children's Cancer Hospital, Egypt
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19
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Wilhelm M, Dirksen U, Bielack SS, Whelan JS, Lewis IJ, Jürgens H, Ferrari S, Sundby Hall K, Cleton-Jansen AM, Stark D. ENCCA WP17-WP7 consensus paper on teenagers and young adults (TYA) with bone sarcomas. Ann Oncol 2014; 25:1500-5. [PMID: 24962703 DOI: 10.1093/annonc/mdu153] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Teenagers and young adults (TYA) cancer contributes substantially to morbidity and mortality in a population with much to offer society. TYA place distinct challenges upon cancer care services, many reporting feeling marginalized and their needs not being met in adult or paediatric cancer services. Bone tumours such as osteosarcoma and Ewing sarcoma, because of their age at presentation and the complexity of their care, are where challenges in managing (TYA) with cancer have often been most readily apparent. Bone sarcomas may be managed by paediatric or medical oncologists, and require fastidious attention to protocol. A lack of recent improvement in survival in TYA with bone tumours may be linked to a lack of specialist care, poor concordance with therapy in some situations and TYA-specific pharmacology. Participation in clinical trials, particularly of young adults, is low, hindering progress. All these requirements may be best met by a concerted effort to create collaborative care between adult and paediatric experts in bone sarcoma, working together to meet TYA patients' needs.
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Affiliation(s)
- M Wilhelm
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - U Dirksen
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S S Bielack
- Cooperative Osteosarcoma Study Group (COSS), Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum-Stuttgart Olgahospital, Stuttgart
| | - J S Whelan
- Teenage and Young Adult Unit, Department of Oncology, University College Hospital, London
| | - I J Lewis
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H Jürgens
- Cooperative Ewing Sarcoma Study Group, Pediatric Hematology and Oncology, Hospital Muenster, Westfalian Wilhelms University, Muenster, Germany
| | - S Ferrari
- Italian Sarcoma Group (ISG), Chemioterapia, Bone Tumor Center, Istituto Rizzoli, Bologna, Italy
| | - K Sundby Hall
- Scandinavian Sarcoma Group (SSG), Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - A M Cleton-Jansen
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D Stark
- Department of Medical Oncology, St James's Institute of Oncology, St James's University Hospital Leeds, Leeds, UK
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20
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Ek ETH, Choong PFM. The role of high-dose therapy and autologous stem cell transplantation for pediatric bone and soft tissue sarcomas. Expert Rev Anticancer Ther 2014; 6:225-37. [PMID: 16445375 DOI: 10.1586/14737140.6.2.225] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The prognosis for children with bone and soft tissue sarcomas has significantly improved since the advent of effective multiagent chemotherapy, aggressive surgery for local disease and more precise delivery of radiotherapy doses. However, in a small proportion of patients that present with high-risk disease, long-term outcome has not substantially increased, with disease-free survival rates still in the order of 20-30%. It is therefore clear that novel therapies are needed for children with these tumors. Based on the highly chemosensitive nature of the majority of pediatric sarcomas, several small studies have been conducted to investigate the potential role of high-dose chemotherapy followed by hematopoietic stem cell reconstitution. This review will provide an overview of the current literature concerning the use of high-dose therapy with stem cell transplantation for the three main pediatric sarcomas--Ewing sarcoma, rhabdomyosarcoma and osteosarcoma.
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Affiliation(s)
- Eugene T H Ek
- Department of Orthopedics, St. Vincent's Hospital, Melbourne, Australia.
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Bispo Júnior RZ, Camargo OPD. IS THERE ANY DIFFERENCE IN THE PROGNOSIS FOR PATIENTS WITH PRIMARY OSTEOSARCOMA WITH A POOR RESPONSE TO NEOADJUVANT CHEMOTHERAPY BETWEEN HUVOS GRADES I AND II? Rev Bras Ortop 2011; 46:420-3. [PMID: 27027032 PMCID: PMC4799283 DOI: 10.1016/s2255-4971(15)30256-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 07/17/2010] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED Would there be any difference in the prognosis for patients who presented, for example, 8% or 88% tumor necrosis induced by chemotherapy, even though both individuals were considered to be poor responders? The aim of this study was to compare the prognoses for different histological grades (Huvos grade I versus grade II), consequent to chemotherapy, among patients with primary osteosarcoma that was not metastatic at diagnosis. METHODS Twenty-four patients admitted to a referral center between 2000 and 2004 were selected for the study. The accumulated chances of survival were calculated using the Kaplan-Meier technique. Huvos grades I and II for necrosis consequent to chemotherapy were evaluated as variables in order to determine their prognostic value, in relation to local recurrence-free survival, metastasis-free survival and overall survival, using the log-rank test. RESULTS Comparing Huvos grades I and II, the following P values for survival were attained: local recurrence-free survival (P = 0.731), metastasis-free survival (P = 0.596) and overall survival (P = 0.669). CONCLUSION In this series, Huvos grades I and II did not have any comparative prognostic value and had similar behavior.
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Affiliation(s)
- Rosalvo Zósimo Bispo Júnior
- MSc and PhD in Orthopedics and Traumatology from the School of Medicine, University of São Paulo (FMUSP). Adjunct Professor, School of Medicine, Federal University of Campina Grande (UFCG), Campina Grande, Brazil
| | - Olavo Pires de Camargo
- Titular Professor, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo (DOT/FMUSP), São Paulo, Brazil
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Guimarães APG, Rocha RM, da Cunha IW, Guimarães GC, Carvalho AL, de Camargo B, Lopes A, Squire JA, Soares FA. Prognostic impact of adenomatous polyposis coli gene expression in osteosarcoma of the extremities. Eur J Cancer 2010; 46:3307-15. [DOI: 10.1016/j.ejca.2010.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 05/27/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
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Bispo Júnior RZ, Camargo OPD. Prognostic factors in the survival of patients diagnosed with primary non-metastatic osteosarcoma with a poor response to neoadjuvant chemotherapy. Clinics (Sao Paulo) 2009; 64:1177-86. [PMID: 20037705 PMCID: PMC2797586 DOI: 10.1590/s1807-59322009001200007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 09/17/2009] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Identification of variables that determine the prognosis for osteosarcoma may enable stratification of patients into subgroups with better or worse risk of local recurrence, metastases and death due to the disease. Discovery of such prognostic factors would permit selection of a subgroup of at-risk patients, with the aim of improving the therapeutic effectiveness. OBJECTIVE To identify prognostic factors related to local recurrence-free survival, metastasis-free survival and overall survival among patients with highly malignant primary osteosarcoma that was non-metastatic on diagnosis and had poor response to neoadjuvant chemotherapy. SAMPLE AND METHODS Out of 45 patients admitted to a referral center in Brazil between 2000 and 2004, 24 were selected for this study. RESULTS The adverse factors that influenced the risk of local recurrence and the overall survival in univariate analysis were histological subtype other than osteoblastic (p = 0.017) and tumor size greater than 15 cm (p = 0.048). In relation to metastasis-free survival, the non-osteoblastic subtype had a worse prognosis (p = 0.007). The association of histological subtype maintained its significance in multivariate analysis for all studied survival categories. CONCLUSIONS Tumor size greater than 15 cm is an adverse factor for local recurrence-free survival and overall survival but did not influence metastasis-free survival. The osteosarcoma histological type is a significant independent predictor for local recurrence-free survival, metastasis-free survival and overall survival.
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Carrle D, Bielack S. Osteosarcoma lung metastases detection and principles of multimodal therapy. Cancer Treat Res 2009; 152:165-184. [PMID: 20213390 DOI: 10.1007/978-1-4419-0284-9_8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The management of pulmonary metastases poses a challenge to the multidisciplinary team involved in the treatment of osteosarcoma. A postal survey on the management of pulmonary metastases in osteosarcoma involving 17 representatives from international study groups and selected institutions was performed in which a response rate of 94% was achieved. The results showed uniform approaches in areas like the imaging methods used for initial staging and the use of manual exploration with thoracotomy. However, it demonstrated diverse practices regarding exploration of the unaffected site in unilateral pulmonary disease, and the approach to lesions disappearing under chemotherapy. Furthermore, agreement on the size of a lesion considered to distinguish between benign and of metastatic origin, varied. Based on the survey and a review of the current literature, detection methods and principles of multimodal therapy will be discussed. Prognostic factors in synchronous and metachronous pulmonary metastases and their implications for a multimodal therapy is also presented.
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Affiliation(s)
- Dorothe Carrle
- Pediatrics 5 (Oncology, Haematology, Immunology), Klinikum Stuttgart, Olgahospital, Bismarckstr. 8, D-70176, Stuttgart, Germany.
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Martin S, Ulrich C, Munsell M, Taylor S, Lange G, Bleyer A. Delays in Cancer Diagnosis in Underinsured Young Adults and Older Adolescents. Oncologist 2007; 12:816-24. [PMID: 17673613 DOI: 10.1634/theoncologist.12-7-816] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the U.S., adolescents and young adults diagnosed with cancer have had less survival improvement than older or younger patients, a deficit that may be a result of delays in diagnosis in an age group with the lowest rates of health insurance. METHODS The relationship between health insurance status and the time from the onset of first cancer-specific symptom or sign to definitive diagnosis (lagtime) was retrospectively compared with other sociodemographic factors in newly diagnosed cancer patients aged 15-29 years who were evaluated between June 2001 and June 2003. Data on 270 patients with the six most common cancer types in this cohort (leukemia, Hodgkin's and non-Hodgkin's lymphoma, sarcoma, brain tumors, thyroid cancer) were retrospectively collected in 2004. RESULTS Lagtimes were evaluable in 235 (88%) patients. In multivariate analysis, the type of cancer and health insurance were significantly associated with lagtime, whereas race/ethnicity, age, gender, marital status, and surrogate measures of socioeconomic status were not. The mean lagtime in patients with public or no health insurance was 13.1 weeks longer than in patients with private health insurance, and longer in four of six evaluable histology-specific types of cancer. In cancers evaluable for stage at diagnosis, advanced stage was associated with longer lagtimes. CONCLUSION In the U.S., older adolescents and young adults with cancer are likely to have a delay in diagnosis because of inadequate health insurance and consequently present with a more advanced stage of disease.
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Affiliation(s)
- Sean Martin
- University of Colorado Health Sciences Center, Denver, CO 80231, USA.
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Petrilli AS, de Camargo B, Filho VO, Bruniera P, Brunetto AL, Jesus-Garcia R, Camargo OP, Pena W, Péricles P, Davi A, Prospero JD, Alves MTS, Oliveira CR, Macedo CRD, Mendes WL, Almeida MTA, Borsato ML, dos Santos TM, Ortega J, Consentino E. Results of the Brazilian Osteosarcoma Treatment Group Studies III and IV: prognostic factors and impact on survival. J Clin Oncol 2006; 24:1161-8. [PMID: 16505436 DOI: 10.1200/jco.2005.03.5352] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the impact of chemotherapy and surgery on the outcome of osteosarcoma (OS) of the extremities and to identify prognostic factors in Brazilian patients. PATIENTS AND METHODS A total of 225 patients with metastatic and nonmetastatic OS of the extremities were enrolled and assessed in two consecutive studies designed and implemented by the Brazilian Osteosarcoma Treatment Group. RESULTS The 5-year survival and event-free survival rates for the 209 assessable patients were 50.1% and 39%, respectively; for the 178 patients with nonmetastatic disease at diagnosis, the rates were 60.5% and 45.5%, respectively. The multivariate analysis showed that the following variables were associated with a shorter survival: metastases at diagnosis (P < .001), necrosis grades 1 and 2 (P = .046), and tumor size (P = .0071). CONCLUSION The overall 5- and 10-year survival rates were lower than the rates reported in North American and European trials. A pattern of advanced disease at diagnosis was often present, with a high proportion of patients having metastases (20.8%) and large tumor size (42.9%). However, these features were not necessarily associated with longer duration of prediagnostic symptoms. These findings were considered in the strategic planning of the current Brazilian cooperative study, with the aim of improving survival and quality of life of a large number of patients with OS.
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Affiliation(s)
- A Sérgio Petrilli
- Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e à Criança com Câncer/Universidade Federal de São Paulo, São Paulo, Brazil.
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Mialou V, Philip T, Kalifa C, Perol D, Gentet JC, Marec-Berard P, Pacquement H, Chastagner P, Defaschelles AS, Hartmann O. Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience. Cancer 2005; 104:1100-9. [PMID: 16015627 DOI: 10.1002/cncr.21263] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents who presented with metastatic osteosarcoma at diagnosis. Patients were treated in six French pediatric oncology centers with surgery and multiagent chemotherapy, mainly with high-dose methotrexate. Their medical records were reviewed retrospectively. METHODS The medical records of patients who were treated for metastatic osteosarcoma from 1987 to 2000 were reviewed. Patients were treated with the chemotherapy regimens recommended for nonmetastatic disease in children (the French Society of Pediatric Oncology OS 87 and OS 94 protocols) or, in a few patients, with other chemotherapy regimens. Surgical excision of the primary tumor and, when possible, of all metastatic sites was performed based on a personalized assessment of each patient's situation. RESULTS Seventy-eight patients age < 20 years were treated. Forty-six patients (59%) had only 1 metastatic site (35 to the lungs and 11 to bone). Twenty-eight patients (36%) achieved a complete remission after combination chemotherapy and surgery. The event-free survival and overall survival rates at 5 years were 14% and 19%, respectively. To date, 14 patients (18%) have remained alive with a median follow-up of 112 months. Pretreatment features associated with a shorter event-free survival in the multivariate analysis were metastasis to at least two organs and high alkaline phosphatase level. Patients with at least 1 of these poor prognostic factors had a 2.6% event-free survival rate at 5 years despite treatment. CONCLUSIONS The survival of patients with metastatic osteosarcoma were treated with conventional chemotherapy and surgery remained very poor. Patients should be classified into different prognostic groups and treated accordingly. New therapeutic approaches are warranted to improve the prognosis for patients with the most severe disease.
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Affiliation(s)
- Valerie Mialou
- Pediatrics Department, Leon Berard Center, Lyon, France.
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