Comparative analysis between osteosarcoma and Ewing's sarcoma: evaluation of the time from onset of signs and symptoms until diagnosis

Lumbar spine Ewing sarcoma: A report of a rare localization

INTRODUCTION

Ewing sarcoma is an aggressive tumor characterized by small round cells and diffuse CD99 positivity seen mainly in Caucasian childhood and adolescent demographics. Ewing sarcoma of spinal origin accounts for approximately 3-9 % of cases most of these cases affecting the sacrum, therefore lumbar lesions are considered quite rare.

CASE REPORT

We report a case of lumbar Ewing sarcoma in a 6-year-old female who presented with back pain and neurological symptoms of spinal compression such as lower limb weakness, constipation, and urinary retention. MRI imaging confirmed the presence of a mass located at the level of L4 and L5 vertebrates causing spinal cord compression, The patient underwent local resection of the tumor, and a biopsy was sent for histology and immunophenotyping which affirmed the diagnosis of Ewing sarcoma. The patient was referred to an oncology center for follow-up chemotherapy.

CLINICAL DISCUSSION

Ewing sarcoma is the second most common tumor of childhood and adolescence. However, a tumor arising from the spine is considered rare. It presents with localized symptoms of pain and fever but may cause neural compression symptoms. Accurate diagnosis relies mainly on radiological scans, histology, and immunohistochemical analysis.

CONCLUSION

Although Ewing sarcoma of the lumbar spine is rare, it should always be considered among pediatric populations developing localized fever and pain. Early detection is crucial to avoid undesired outcomes.

Distinct Gene Expression and Immune Features Between Different Neutrophil Extracellular Trap-Related Osteosarcoma Subtypes

We sought to determine neutrophil extracellular trap (NET)-related genes' potential value in improving the efficacy of diagnosis and identifying novel therapeutic targets for osteosarcoma. Data were obtained from TARGET, GEO, and CCLE database. Differentially expressed genes were identified between the subtypes based on NET-related genes. PPI network was constructed using STRING, following by ClueGO enrichment analysis. Infiltration of immune cells was calculated by ssGSEA. Risk Score model was built by LASSO Cox regression analysis. Western blot and qRT-PCR were applied to validate the expression of genes used in the model. We identified 19 NET-related genes with prognostic potential in osteosarcoma using univariate Cox regression analysis. Patients from TARGET were clustered into two subtypes with distinct prognosis and immune features. 381 DEGs were identified between the two NET subtypes. Risk Score based on BST1, SELPLG, FPR1 and TNFRSF10C was reliable to predict the prognosis of osteosarcoma patients. The four genes expressed significantly lower in osteosarcoma than normal cells. Low Risk Score individuals only existed in C1 subtype with better prognosis. Osteosarcoma were clustered into two subtypes based on NET-related genes. Risk Score model constructed by four NET-related gene was able to independently predict the prognosis of osteosarcoma.

Assessment of the Interval to Diagnosis in Pediatric Bone Sarcoma

OBJECTIVES

The timely diagnosis of primary bone malignancies in pediatric patients is critical to clinical outcomes. The purpose of this study is to investigate the initial presentation of pediatric bone sarcoma patients to an academic health care system and assess the current interval to diagnosis.

METHODS

We conducted a retrospective review of pediatric patients (aged 1-18) with biopsy-proven diagnosis of osteosarcoma or Ewing sarcoma presenting between 2004 and 2020. All living patients had 1 year or more of follow-up. Primary outcomes were interval to diagnosis, clinical features on initial presentation, percent of patients with negative radiographic workup at initial presentation, and number of health care encounters before diagnosis.

RESULTS

Seventy-one patients (osteosarcoma, 51; Ewing sarcoma, 20) were included. Average age at presentation was 13.1 ± 3.3 years (range, 4.4-18.3). Average symptom duration was 5.4 ± 13.9 months (range, 0.1-84). Clinical features at initial presentation included limb/back pain (91.5% of patients), activity modification/pain medication use (78.9%), palpable mass (40.8%), night pain (35.2%), limp (25.4%), limb disuse (18.3%), and recent fever history (2.8%). Fourteen of 71 patients (19.7%) had negative radiographs at initial presentation. Average number of health care encounters before diagnosis was 1.9 ± 0.6 (range, 1.0-4.0), with most in the outpatient pediatrician clinics (81.2%) and emergency department (18.3%). Average time to diagnosis from initial presentation was 19.5 ± 65 days (range, 0-493); the 14 patients with initial negative radiographs had a statistically significant prolonged interval to diagnosis of 54 ± 134 days (range, 0-493; P = 0.018).

CONCLUSIONS

We found pediatric patients with primary bone sarcoma present with an average interval to diagnosis of 20 days. Twenty percent of patients had a significantly prolonged interval to diagnosis of 54 days. Clinical features suggest night pain is not a sensitive indicator. In patients of appropriate age with persistent unilateral pain in suspicious locations, early advanced imaging with magnetic resonance imaging should be considered.

Enhancing Healthcare for Sarcoma Patients: Lessons from a Diagnostic Pathway Efficiency Analysis

Sarcomas, rare and with lower survival rates than common tumors, offer insights into healthcare efficiency via the analysis of the total interval of the diagnostic pathway, combining the patient interval (time between the first symptom and visit with a physician) and diagnostic interval (time between first physician visit and histological diagnosis). Switzerland's healthcare system, Europe's costliest, lacks research on treating rare conditions, like mesenchymal tumors. This study examines the total interval of the diagnostic pathway for optimization strategies. Analyzing a dataset of 1028 patients presented from 2018 to 2021 to the Swiss Sarcoma Board (MDT/SB-SSN), this retrospective analysis delves into bone sarcoma (BS), soft-tissue sarcoma (STS), and their benign counterparts. Demographic and treatment data were extracted from medical records. The patient interval accounted for the largest proportion of the total interval and secondary care interval for the largest proportion of the diagnostic interval. Age, grade, and localization could be elicited as influencing factors of the length of different components of the total interval. An increasing age and tumor size, as well as the axial localization, could be elicited as factors increasing the probability of sarcoma. The patient and secondary care interval (SCI) offer the greatest potential for optimization, with SCI being the bottleneck of the diagnostic interval. New organizational structures for care work-ups are needed, such as integrated practice units (IPU) as integral part of value-based healthcare (VBHC).

Osteosarcoma MRI Image-Assisted Segmentation System Base on Guided Aggregated Bilateral Network

Osteosarcoma is a primary malignant tumor. It is difficult to cure and expensive to treat. Generally, diagnosis is made by analyzing MRI images of patients. In the process of clinical diagnosis, the mainstream method is the still time-consuming and laborious manual screening. Modern computer image segmentation technology can realize the automatic processing of the original image of osteosarcoma and assist doctors in diagnosis. However, to achieve a better effect of segmentation, the complexity of the model is relatively high, and the hardware conditions in developing countries are limited, so it is difficult to use it directly. Based on this situation, we propose an osteosarcoma aided segmentation method based on a guided aggregated bilateral network (OSGABN), which improves the segmentation accuracy of the model and greatly reduces the parameter scale, effectively alleviating the above problems. The fast bilateral segmentation network (FaBiNet) is used to segment images. It is a high-precision model with a detail branch that captures low-level information and a lightweight semantic branch that captures high-level semantic context. We used more than 80,000 osteosarcoma MRI images from three hospitals in China for detection, and the results showed that our model can achieve an accuracy of around 0.95 and a params of 2.33 M.

Nanoscale Au@SiO2-drug/VEGF as an in vivo probe for osteosarcoma diagnosis and therapy

Osteosarcoma is a common primary bone malignancy, with a 5-year survival rate of only 20–30% in patients undergoing surgical treatment. Thus, it is important to identify novel methods for diagnosing and treating osteosarcoma, which was the aim of the present study. Vascular endothelial growth factor (VEGF) was used as the tumor-targeting protein to synthesize a multifunctional core-shell nanostructure, Au@SiO₂-drug/VEGF, in which the drug can be indocyanine green (ICG; as an optical tracer) or doxorubicin (DOX; as a chemotherapeutic agent). With VEGF as the osteosarcoma-targeting protein, Au exhibited optimal photothermal transformation performance, while SiO₂ served as the carrier for the drug. Au@SiO₂-ICG/VEGF nanoparticles (NPs) were evaluated for imaging and for the monitoring of drug accumulation in a tumor region in mice. Once the optimal drug accumulation was achieved, combined treatment of osteosarcoma (chemotherapy and photothermal therapy) was assessed. In the perioperative period associated with minimal invasive embolization of osteosarcoma, photothermal therapy and chemotherapy were applied for osteosarcoma diagnosis using Au@SiO₂-DOX/VEGF NPs. Taken together, the results of the present study provide a promising strategy for tumor detection prior to surgical treatment to improve the survival outcome of patients with osteosarcoma.

The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes

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.

Prognostic factors of chondroblastic osteosarcoma and nomogram development for prediction: A population-based, STROBE-compliant study

The present study aimed to develop nomograms to predict survival in patients with chondroblastic osteosarcoma (COS).An analysis was conducted of 320 cases of COS collected from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015. Independent prognostic factors were screened using univariate and multivariate Cox analyses. Subsequently, nomograms were established to predict the patients' cancer-specific survival (CSS) and overall survival (OS) rates. The prediction accuracy and discriminative ability of the nomograms were examined using calibration curves and the concordance index (C-index).As revealed in the univariate and multivariate Cox regression analysis, age, tumor size, the primary site, the presence of metastasis, a history of having undergone surgery, and a history of having received radiotherapy were found to be independent prognostic factors associated with survival in patients with COS (all P < .05). Furthermore, age >39 years, the presence of distant metastasis, no history of having undergone any surgery, and tumor size >103 mm were found to be associated with poor prognosis in patients, while the primary site of the mandible and no history of having undergone radiotherapy showed associations with a more favorable prognosis in patients. Next, nomograms were constructed to predict the OS and CSS in patients with COS.We constructed nomograms that can provide accurate survival predictions in patients with chondroblastic osteosarcoma. These nomograms can help surgeons customize the treatment strategies for patients with chondroblastic osteosarcoma.

Alkaline phosphatase, lactic dehidrogenase, inflammatory variables and apparent diffusion coefficients from MRI for prediction of chemotherapy response in osteosarcoma. A cross sectional study

BACKGROUND

This present study aimed to assess if clinical, laboratory and MRI were an accurate benchmark in assessing the effectiveness of neoadjuvant chemotherapy in osteosarcoma patients.

METHODS

This was an observational analytic study with a cross-sectional design. We correlated among clinical, laboratory and magnetic resonance imaging (MRI) data before and after neoadjuvant chemotherapy; and percentage of tumor necroses from osteosarcoma patients during the period between January 2017-July 2019.

RESULTS

Of the 58 patients included in this study, 38 were male and 20 were female aged 5 - 67 years (mean: 16-year-old. 37(63.8%) patients underwent neoadjuvant chemotherapy with CAI regimens and 13 (36.2%) with CA regiments. The tumors were classified as stage IIB in 43 (74.1%) patients and stage III in 15 (25.9%) patients. Wilcoxon test showed significant differences between alkaline phosphatase (ALP), erythrocyte sedimentation rate (ESR), and neutrophil to lymphocyte ratio (NLR) before and after neoadjuvant chemotherapy in the poor-response group. We found no significant difference between lactic dehydrogenase (LDH) and lymphocyte-to-monocyte ratio (LMR) before and after neoadjuvant chemotherapy in the good-response group. MRI revealed decreased tumor volume in patients in the good-response to chemotherapy.

CONCLUSION

We demonstrated that ALP level was statistically significant in the poor-response group. We also found that LDH value before neoadjuvant chemotherapy had a strong correlation with degree of necrosis and could be used as a predictive indicator. MRI plays an important role in evaluating tumor volumes and preoperative radiological changes to predict histological necrosis.

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?

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.

Prognostic impact of diagnostic and treatment delays in children with osteosarcoma

BACKGROUND

The aim of this study is to evaluate the relationship between the latency to diagnosis (LD) and the time to completion of chemotherapy (TCC) with clinical outcomes in children with osteosarcoma.

METHODS

We performed a retrospective analysis of all patients who received treatment for osteosarcoma in two tertiary centers in Peru from 2008 to 2015. All causes of delayed LD or TCC were evaluated. Overall survival (OS) and event-free-survival (EFS) were estimated and compared according to LD, TCC, and established clinical prognostic factors.

RESULTS

One hundred and thirteen patients were included in the study. The median LD was 13.5 weeks (interquartile range, 10-18.5 weeks). No association was observed among clinical stage, tumor size, and LD. Delayed LD was not associated with a worse clinical outcome. Multivariate analysis confirmed that OS and EFS were significantly worse in cases of a delayed TCC (≥4 weeks), with hazard ratios of 2.70 (1.11-6.76, P = 0.003) and 1.13 (1.00-1.26, P = 0.016), respectively. Most delays in TCC (85%) were due to extramedical reasons (e.g., lack of available hospital beds).

CONCLUSION

The LD did not seem to influence the EFS and OS in pediatric patients with osteosarcoma. However, a delay in TCC from any cause is independently associated with poor outcome in pediatric patients with osteosarcoma. Based on these results, further efforts may be needed to avoid treatment delays in patients with osteosarcoma in middle-income countries.

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil

OBJECTIVE

To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0-29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries.

METHODS

Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days.

RESULTS

There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay.

CONCLUSION

Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

Prognostic factors to survival of patients with chondroblastic osteosarcoma

This study was aimed to reveal the changes in survival rates and prognostic factors to survival of chondroblastic osteosarcoma (COS).Patients from the Surveillance, Epidemiology, and End Results (SEER) database were retrieved. Kaplan-Meier survival analysis and Cox proportional hazard model were used during analysis.There were significant differences on overall survival between subtypes of osteosarcoma (P < .001*). Overall survival of COS did not change significantly during last forty years (P = .610), and cancer-specific survival increased to a plateau in 1980s and then remained stable (P = .058). Younger onset age, patients of white race, well and moderately differentiated tumors, and surgery independently predicted better overall (Hazard ratio [HR]: 1.034, P < .001*; HR: 0.538, P = .004*; HR: 0.240, P = .020* and HR: 0.350, P < .001*, respectively) and cancer-specific (HR: 1.031, P = .002*; HR: 0.592, P = .036*; HR: 0.098, P = .027* and HR: 0.253, P < .001*, respectively) survival. Metastasis at diagnosis independently predicted worse overall (HR: 3.108, P < .001*) and cancer-specific (HR: 4.26, P < .001*) survival compared to no metastasis.Younger onset age, white race, well and moderately differentiated tumors, no metastasis at diagnosis and surgical resection can independently predict better overall and cancer-specific survival of COS.

Ewing's Sarcoma with Metachronous Pulmonary Metastasis after Successful Treatment of Osteosarcoma in a Child

A rare case of duplicate tumor, osteosarcoma and Ewing's sarcoma, complicated by metachronous pulmonary metastasis in a child is reported. A nine-year-old girl's osteosarcoma was treated by neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy. Four years later, resection of the chest wall to remove an Ewing's sarcoma had to be performed, followed by chemotherapy and radiotherapy. At the age of 17, the girl underwent a metastasectomy of Ewing's sarcoma metastasis to the lung. Five years later, the patient is free from any recognizable malignant disease. We conclude that after the complete surgical removal of two primary tumors, metastasectomy is an optimal treatment procedure in case of a solitary pulmonary metastasis.

Chondroblastic osteosarcoma

The purpose of this paper is to report a case of chondroblastic osteosarcoma in the region of the maxilla, with 5 months of evolution. The term osteosarcoma refers to a heterogeneous group of malignancies with bone formation or mesenchymal tissue with histopathological evidence of osteogenic differentiation. The pattern of chondroblastic osteosarcoma represents 25% of all reported cases of this neoplasm. Its histopathological diagnosis is based on the predominance of a chondroid matrix formed in the midst of neoplastic cells. A woman patient, 27-year old, melanoderm, presented on extraoral exam with facial asymmetry caused by the a swelling in the premaxillary region with upper lip protrusion. Intraoral exam showed a maxillary tumefaction with involvement of the vestibular and palatine regions. The computerized tomography (CT) analysis exhibited a radiolucent mass with dispersed areas of radiopacity, with poorly defined and indistinct peripheral edges. The patient was subjected to incisional biopsy and histopathological examination showed the presence of a malignant neoplasm of mesenchymal origin characterized by the presence of irregular bone trabeculae dispersed among mildly atypical chondroblastic cells. The World Health Organization (WHO) recognizes several variants that differ in location, clinical behavior and degree of cellular atypia. The conventional or classical osteosarcoma is the most frequent variant, which develops within the medullary bone. This report illustrates the rapid evolution of one of the histological variants of osteosarcoma.

Do malignant bone tumors of the foot have a different biological behavior than sarcomas at other skeletal sites?

We analyze the delay in diagnosis and tumor size of malignant bone tumors of the foot in a retrospective study. We compared the oncological and surgical long-term results with identical tumor at other anatomical sites in order to analyze the biological behavior of sarcomas that are found in the foot. Thirty-two patients with a histologically proven malignant bone tumor (fifteen chondrosarcomas, nine osteosarcomas, and eight Ewing sarcomas) between the years 1969 and 2008 were included. The median follow-up was 11.9 years. The overall median time gap between the beginning of symptoms and diagnosis in the study group was 10 months. Ewing sarcoma presented with the longest delay in diagnosis (median of 18 months), followed by osteosarcoma (median of 15 months) and chondrosarcoma (median of 7.5 months). The delay in diagnosis of these tumors was significantly longer than that of equivalent tumors at other skeletal sites, but the 5- and 10-year survival rates and the occurrence of distant metastases were comparable. In contrast, the average size of foot tumors was 5- to 30-fold less than that of tumors analyzed at other skeletal sites. This study indicates that sarcomas of the foot demonstrate a distinct biological behavior compared to the same tumor types at other skeletal sites.

Osteosarcoma in the distal femur two years after an ipsilateral femoral shaft fracture: a case report

Introduction

The duration of symptoms preceding a definitive diagnosis of osteosarcoma is quite long. Pathological radiological signs are often evident by the time of diagnosis. Although several case reports have been published on osteosarcoma of the femur, to the best of our knowledge this report is the first one with such an unusual clinical course.

Case presentation

We describe the case of a 58-year-old Caucasian man who presented with a femoral shaft fracture. Two years post-trauma osteosarcoma in the ipsilateral distal femur was diagnosed. Was it coincidence? We think that the history of the trauma is crucial to answering this question.

Conclusion

This case report underlines the need to keep up awareness of pathological fractures in emergency medicine and trauma surgery. When radiographs do not raise any suspicion but the history of trauma or the physical examination does, we recommend further radiological and/or histological diagnostic examinations.

The symptom interval in children and adolescents with soft tissue sarcomas

BACKGROUND

In a series of 575 patients < or =21 years of age with soft tissue sarcomas (STSs), the authors investigated the association patterns between symptom interval (ie, the period between the onset of the first symptoms or signs of the disease and its definitive diagnosis) and patient/tumor characteristics or disease outcome (in terms of survival).

METHODS

The analysis was based on multivariate models (linear for associations with patient/tumor characteristics and Cox's for survival).

RESULTS

The symptom interval ranged between 1 week and 60 months (median, 2 months) and tended to be longer the older the patient (ie, the interval was longer in adolescents than in children) and the larger the tumor's size, and for tumors located at the extremities and for nonrhabdomyosarcoma STSs (as opposed to rhabdomyosarcomas). A longer symptom interval unfavorably influenced survival (P = .002), which was also significantly affected by the patient's age and the size and surgical stage of the tumor. A different pattern of association between symptom interval and survival emerged for different types of STS histology.

CONCLUSIONS

Our study points to an independent prognostic effect of symptom interval that cannot be explained by its associations with other factors, such as patient's age or the site, size, stage, and histology of the tumor. Future studies should focus more on the possible causes of symptom interval in pediatric STS populations to enable corrective measures to be implemented to reduce the diagnostic delay.

Treatment results of the Ewing sarcoma of bone and prognostic factors

BACKGROUND

The purpose of this study is to assess the clinical outcome of patients with ESFT of the bone treated with the European Intergroup Cooperative Ewings Sarcoma Study (EICESS)-92 treatment protocol at a single center, and to identify prognostic factors.

METHODS

Ninety-eight patients younger than 18 years of age, diagnosed with ESFT of the bone between 1992 and 2005, were analyzed retrospectively.

RESULTS

Eighty-seven patients were treated with the EICESS-92 protocol. The median follow-up was 105 +/- 38 months. The 5-year event-free survival (EFS) survival rate was 40%, the 5-year overall survival (OS) rate was 47%. For non-metastatic disease, the rates of 5-year EFS and OS were 45% and 51%. These rates were 18% and 27%, for metastatic disease. The 5-year EFS and OS rates were 17% and 30%, respectively for females. For males, theses rates were 45% and 48%. Of 87 patients, 52 were admitted with primary extremity lesions. Distant metastasis was detected in 48% of patients with a metaphyseal tumor. In patients with diaphyseal lesions, it was 17%. The 5-year EFS and OS were 35% and 43%, respectively. In non-metastatic disease, these measures were 43% and 50%, whereas in metastatic disease, they were 20% and 27%. In patients with a lesion originating from metaphysis, the 5-year EFS was 17%, and the 5-year OS was 29%, for patients with a diaphyseal lesion, these values were 50% and 54%.

CONCLUSION

The presence of metastasis was closely related with metaphyseal tumors. The localization of tumor in the bone (i.e., diaphyseal or metaphyseal) and gender of patients seem to have prognostic importance.

Prognostic factors in the survival of patients diagnosed with primary non-metastatic osteosarcoma with a poor response to neoadjuvant chemotherapy

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.

Classical osteoblastoma, atypical osteoblastoma, and osteosarcoma: a comparative study based on clinical, histological, and biological parameters

OBJECTIVE

To investigate the biological behavior of classical and atypical osteoblastomas in comparison to osteosarcomas.

METHODS

Based on histological parameters, 30 osteoblastomas were subclassified as classical osteoblastomas (23/30) or atypical osteoblastoma (high cellularity, prominent blue osteoid, and epithelioid osteoblasts--7/30). Comparative immunohistochemical and clinical analysis was performed in 17 cases of patients with high-grade osteosarcoma. Formalin-fixed, paraffin-embedded archival tissue was immunostained for p53 and proliferation cell nuclear antigen. Tumors with positive p53 stain underwent molecular analyses for fragments of exon 10.

RESULTS

The mean proliferating cell nuclear antigen indexes for classical osteoblastoma, atypical osteoblastoma, and osteosarcoma were 33%, 61%, and 79%, respectively. The atypical subgroup showed similar results to those of the osteosarcoma group (P < 0.001). p53 protein was detected in 4 (13%) osteoblastomas (3 of these were atypical osteoblastoma), and 4 osteosarcomas (23%) also showed p53 positivity. DNA mutation performed in p53-positive cases was confirmed in exon 10 in 2 atypical osteoblastomas (2/3), 1 classical osteoblastoma (1/1), and 1 osteosarcoma (1/4). Disease recurrence was correlated with p53 expression (P = 0.009), atypical subtype (P = 0.031), spiculated blue bone on histology (P = 0.018), and proliferating-cell nuclear antigen labeling index > or =40 (P = 0.015).

CONCLUSION

These results validate atypical osteoblastoma as an entity, with p53 and proliferation cell nuclear antigen immuno-expression closer to that of osteosarcoma than of classical osteoblastoma. Proliferating cell nuclear antigen labeling index and p53 may be useful predictors of recurrence.