Limb-saving surgery, survival, and prognostic factors for osteosarcoma: The Hungarian experience

Background and Objectives: There are many factors thought to have an influe nce on the prognosis of osteosarcoma that have been reported in the literat ure. Their significance, however, still remains controversial in most cases . Experience with osteogenic sarcoma (OS) was reviewed in order to evaluate surgical results and survival and to determine the prognostic factors. Methods: Ninety-six patients with high-grade osteosarcoma of the extremitie s were treated between 1986 and 1997 in the authors' institution. They were divided into 3 groups: In group I, all 75 patients with non-metastatic OS received intensive chemotherapy (high-dose methotrexate, doxorubicin, ifosf amide, and cisplatin) and underwent surgery. In group II, 9 patients alread y had metastases at the time of referral. In group III, 12 patients receive d chemotherapy in delayed or suboptimal form. Results and Conclusions: In group I, there were local recurrences in 3 pati ents (7%) and metastases in 8 patients (20%) with limb-saving, whereas thes e numbers were 1 (3%) and 14 (38%) in those who had amputation. The 5-year disease-free survival (DFS) was 72% and 69% in the limb-saving and amputati on groups, respectively. In groups II and III, 5-year DFS was extremely poo r, 10% and 20% only, underlining the importance of stage and intensity of c hemotherapy, respectively. With univariate analysis, sex, duration of sympt oms, and radiographic appearance of OS had no prognostic value, whereas tum or volume <60 cm(3), wide or radical surgical margin, distal location of OS , cartilagineous ground substance <20%, and response to chemotherapy were p ositive prognostic factors. The last 4 variables maintained their significa nce in the multivariate Cox model as well. Age >30 years showed indirect ne gative influence on the final outcome through enhanced intolerability to th e drugs and less cooperability of the patients. The results on survival wit h limb-saving surgery were well comparable with those of amputation. (C) 20 00 Wiley-Liss, Inc.