Journal List > J Korean Bone Joint Tumor Soc > v.18(2) > 1052012

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Choi, Han, Cho, and Kim: Effect of Preoperative Chemotherapy on Survival in High-grade Localized Osteosarcoma of the Extremity
Original Article
The Journal of the Korean Bone and Joint Tumor Society

The Journal of the Korean Bone and Joint Tumor Society 2012; 18(2): 59-65.

Published online: 21 December 2012

DOI: https://doi.org/10.5292/jkbjts.2012.18.2.59

Effect of Preoperative Chemotherapy on Survival in High-grade Localized Osteosarcoma of the Extremity

Eun-Seok Choi, Ilkyu Han, Hwan Seong Cho, Han-Soo Kim

Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to: Han-Soo Kim. Department of Orthopaedic Surgery, Seoul National University College of Medicine, 101, Daehang-no, Jongno-gu, Seoul 110-744, Korea. TEL: +82-2-2072-2362, FAX: +82-2-764-2718, hankim@snu.ac.kr

Received 18 October 2012       Revised 9 November 2012       Accepted 12 November 2012

Copyright © 2012 by The Korean Bone and Joint Tumor Society

(open-access):

"This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited."

Abstract

Purpose

Multidisciplinary approaches of surgical resection and chemotherapy have been widely used for the treatment of non-metastatic osteosarcomas. We aimed to assess the effect of neoadjuvant chemotherapy for metastasis and disease-specific survival.

Materials and Methods

Authors retrospectively reviewed 225 young (<30 years old) and non-metastatic osteosarcoma patients who underwent surgical resection and postoperative chemotherapy between February 1984 and July 2010. Mean age was 14.4 years old (ranged: 4-29 years old) and average follow-up period was 9.1 years (2-28 years). The patients were divided into two groups according to the application of preoperative chemotherapy. Both groups were compared with clinical characteristics, metastasis-free survival and disease-specific survival.

Results

All of 225 patients, 32 patients were treated with postoperative chemotherapy and 193 patients were performed preoperative and postoperative chemotherapy. Postoperative chemotherapy group showed significantly high rate of amputation (p<0.001). Metastasis was occurred in 101 patients. Postoperative chemotherapy group indicated significant higher rate of metastasis (69% vs 41%, p=0.004) and early development of metastasis (mean: 11.5 vs 20.3 months, p=0.045) than pre-and postoperative chemotherapy group. Fifty-seven patients were died of osteosarcoma. Postoperative chemotherapy group revealed significant lower rate of 5-year disease-specific survival than pre-and postoperative chemotherapy group (51% vs 84%, p=0.001). Adult (>15 years) and large sized tumor (>8 cm) were meaningful risk factors of metastasis and disease-specific survival. Although, local recurrences were occurred in 13 patients, there was no significant difference.

Conclusion

Neoadjuvant chemotherapy offers better disease-specific survival and metastasis-free survival.

Keywords: osteosarcoma, chemotherapy, preoperative chemotherapy, survival

Figures and Tables

Figure 1
(A) Kaplan-Meier method and Mantel-Cox test showed that metastasis free survival rate was higher in neoadjuvant and adjuvant chemotherapy group than adjuvant chemotherapy group. (B) Graph about the time to metastasis from surgery revealed that metastasis occurred earlier in adjuvant chemotherapy group than neoadjuvant and adjuvant chemotherapy group.
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Figure 2
Kaplan-Meier method and Mantel-Cox test of disease-specific survival indicated that survival rate of neoadjuvant and adjuvant chemotherapy group was significantly higher than adjuvant chemotherapy group (p=0.001).
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Figure 3
Comparison of metastasis-free and disease-specific survival about the patients who were treated in 1980's. (A) Kaplan-Meier method and Mantel-Cox test of metastasis-free survival indicated that survival rate of neoadjuvant and adjuvant chemotherapy group was significantly higher than adjuvant chemotherapy group (p=0.009). (B) Disease-specific survival was higher in neoadjuvant and adjuvant chemotherapy group, also (p=0.011).
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Table 1
Clinical Characteristics
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*Statistically significant variables.

Table 2
Factors affecting Metastasis-Free Survival
jkbjts-18-59-i002

*Significant variable of univariate analysis.

†Significant variable both of univariate and multivariate analysis.

Table 3
Factors affecting Disease-specific Survival
jkbjts-18-59-i003

*Significant variable of Univariate Analysis.

†Significant variable both of Univariate and Multivariate Analysis.

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