Prognostic factors in non-metastatic limb osteosarcoma: A 20-year experience of one center

The purpose of this study was to evaluate the prognostic significance of va riables in osteosarcoma. We performed a retrospective analysis of 35 patien ts with non-metastatic limb osteosarcoma that were treated between 1973 and 1994. The following variables were evaluated: age, sex, ethnic group, tumo r histology and primary site, alkaline phosphatase (ALP) and lactate dehydr ogenase (LDH) levels at diagnosis, treatment regimen, and the histologic re sponse to treatment. Three variables showed significant correlation with pr ognosis: i) Histologic response to preoperative treatment. Disease-free sur vival (DFS) was 89% in patients with grade III-IV histologic response after a median follow-up (MFU) of 64 months, 67% in patients with grade II after an MFU of 64 months, the patients with grade I response died within 15 mon ths (p<0.0001); ii) Treatment regimen. DFS was 83% after an MFU of 42 month s, 62% after an MFU of 82 months, and 30% after an MFU of 177 months in pat ients treated by the 90's, 80's, and 70's protocols, respectively (p<0.05); iii) corrected ALP (cALP) levels at diagnosis. DFS was 78% after an MFU of 88 months in patients with cALP levels <200, and 32% after an MFU of 56 mo nths in patients with cALP levels >200 (p=0.01). Low ALP levels, good histo logic response to preoperative chemotherapy, and the new therapeutic regime n correlated with good prognosis in patients with osteosarcoma.