Postmetastasis survival in high-grade extremity osteosarcoma: A retrospective analysis of prognostic factors in 126 patients

Background and Objectives

Prognostic factors predictive of postmetastasis survival (PMS) in metastatic osteosarcoma are poorly understood. Our aims were to evaluate PMS in patients with high-grade osteosarcoma in extremities, and to identify prognostic factors related to PMS.

Methods

A retrospective review of data for 126 patients with metastatic osteosarcoma was conducted. The study population consisted of 70 men and 56 women, with a mean age of 21 years (range: 4-75 years). The mean postmetastasis follow-up period was 37 months (range: 1-245 months).

Results

The 5-year PMS rate was 31% and median PMS duration was 22 months. In the multivariate analyses, no metastasectomy (P < 0.001), local recurrence prior to metastasis (P = 0.016), extrapulmonary metastasis (P = 0.006), and poor histologic response to preoperative chemotherapy (P = 0.047) were significant poor prognostic factors. The 5-year PMS without any negative prognostic factor was 60.2%; with one factor, 31.6%; and with more than two factors, 3.6%.

Conclusions

PMS in osteosarcoma patients was influenced by primary tumor-related factors such as histologic response to chemotherapy, as well as metastasis-related factors such as complete metastasectomy and metastasis site. A certain group of patients without such poor prognostic factors could be cured even after the development of metastasis.

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