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Prognostic Factors in Elderly Osteosarcoma Patients: A Multi-institutional Retrospective Study of 86 Cases

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The occurrence of osteosarcoma in elderly patients has recently been increasing, and the outcome is poor. This multi-institutional retrospective study was conducted to investigate clinical features and prognostic factors in patients older than 40 years with osteosarcoma.

Methods

Patients with conventional high-grade osteosarcoma older than 40 years were recruited to this study. Secondary osteosarcoma arising from Paget’s disease or irradiated bones was excluded. Information on tumor- and treatment-related factors was collected and statistically analyzed. The median follow-up was 57 months (range 8–244 months) for all surviving patients.

Results

A total of 86 patients were enrolled in this study. The median age at diagnosis was 61 years. Surgery and chemotherapy were conducted in 73 and 63 % of all patients, respectively. The 5-year overall and event-free survival rates were 38.8 and 34.0 %, respectively. Tumor site (extremity 57.9 %; axial 19.0 %; p < 0.0001), metastasis at diagnosis (yes 12.2 %; no 48.3 %; p < 0.0091), and definitive surgery (yes 56.2 %; no 10.6 %; p < 0.0001) were associated with overall survival. Although patients without metastasis who received definitive surgery were regarded as good candidates for chemotherapy, the addition of chemotherapy did not have any impact on the outcome (yes 63.4 %; no 65.2 %; p = 0.511).

Conclusions

The present study revealed the distinct clinical features, such as the high incidence of truncal tumors or metastasis at diagnosis, in patients older than 40 years with osteosarcoma. Additionally, prognostic factor analyses revealed that tumor site, metastasis at diagnosis, definitive surgery, and surgical margins were significant prognostic factors, whereas chemotherapy did not influence survival.

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References

  1. Japan Orthopaedic Association Musculoskeletal Tumor Committee/National Cancer Center. Bone and Soft Tissue Tumor Registry in Japan. 2009.

  2. Bacci G, Ferrari S, Donati D, Longhi A, Bertoni F, Di Fiore M, et al. Neoadjuvant chemotherapy for osteosarcoma of the extremity in patients in the fourth and fifth decade of life. Oncol Rep. 1998;5:1259–63.

    CAS  PubMed  Google Scholar 

  3. Carsi B, Rock MG. Primary osteosarcoma in adults older than 40 years. Clin Orthop. 2002;397:53–61.

    Article  PubMed  Google Scholar 

  4. Grimer RJ, Cannon SR, Taminiau AM, Bielack S, Kempf-Bielack B, Windhager R, et al. Osteosarcoma over the age of forty. Eur J Cancer. 2003;39:157–63.

    Article  CAS  PubMed  Google Scholar 

  5. Huvos AG. Osteogenic sarcoma of bones and soft tissues in older persons. A clinicopathologic analysis of 117 patients older than 60 years. Cancer. 1986;57:1442–9.

    Article  CAS  PubMed  Google Scholar 

  6. Longhi A, Errani C, Gonzales-Arabio D, Ferrari C, Mercuri M. Osteosarcoma in patients older than 65 years. J Clin Oncol. 2008;26:5368–73.

    Article  PubMed  Google Scholar 

  7. Manoso MW, Healey JH, Boland PJ, Athanasian EA, Maki RG, Huvos AG, et al. De novo osteogenic sarcoma in patients older than forty: benefit of multimodality therapy. Clin Orthop. 2005;438:110–5.

    Article  PubMed  Google Scholar 

  8. Naka T, Fukuda T, Shinohara N, Iwamoto Y, Sugioka Y, Tsuneyoshi M. Osteosarcoma versus malignant fibrous histiocytoma of bone in patients older than 40 years. A clinicopathologic and immunohistochemical analysis with special reference to malignant fibrous histiocytoma-like osteosarcoma. Cancer. 1995;76:972–84.

    Article  CAS  PubMed  Google Scholar 

  9. Nishida Y, Isu K, Ueda T, Nishimoto Y, Tsuchiya H, Wada T, et al. Osteosarcoma in the elderly over 60 years: a multicenter study by the Japanese Musculoskeletal Oncology Group. J Surg Oncol. 2009;100:48–54.

    Article  PubMed  Google Scholar 

  10. Okada K, Hasegawa T, Nishida J, Ogose A, Tajino T, Osanai T, et al. Osteosarcomas after the age of 50: a clinicopathologic study of 64 cases—an experience in northern Japan. Ann Surg Oncol. 2004;11:998–1004.

    Article  PubMed  Google Scholar 

  11. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. American Joint Committee on Cancer Staging Manual. 7th ed. New York: Springer, 2009.

    Google Scholar 

  12. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop. 1980;153:106–20.

    PubMed  Google Scholar 

  13. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  14. Huvos AG, Rosen G, Marcove RC. Primary osteogenic sarcoma: pathologic aspects in 20 patients after treatment with chemotherapy en bloc resection, and prosthetic bone replacement. Arch Pathol Lab Med. 1977;101:14–8.

    CAS  PubMed  Google Scholar 

  15. Imai R, Kamada T, Tsuji H, Tsujii H, Tsuburai Y, Tatezaki S. Cervical spine osteosarcoma treated with carbon-ion radiotherapy. Lancet Oncol. 2006;7:1034–5.

    Article  PubMed  Google Scholar 

  16. Kamada T, Tsujii H, Tsuji H, Yanagi T, Mizoe JE, Miyamoto T, et al. Efficacy and safety of carbon ion radiotherapy in bone and soft tissue sarcomas. J Clin Oncol. 2002;20:4466–71.

    Article  CAS  PubMed  Google Scholar 

  17. Duffaud F, Digue L, Baciuchka-Palmaro M, Volot F, Perles-Daniel C, Garbe L, et al. Osteosarcomas of flat bones in adolescents and adults. Cancer. 2000;88:324–32.

    Article  CAS  PubMed  Google Scholar 

  18. Mankin HJ, Hornicek FJ. Paget’s sarcoma: a historical and outcome review. Clin Orthop. 2005;438:97–102.

    Article  PubMed  Google Scholar 

  19. Bielack SS, Kempf-Bielack B, Heise U, Schwenzer D, Winkler K. Combined modality treatment for osteosarcoma occurring as a second malignant disease. Cooperative German-Austrian-Swiss Osteosarcoma Study Group. J Clin Oncol. 1999;17:1164–74.

    CAS  PubMed  Google Scholar 

  20. Bielack SS, Wulff B, Delling G, Göbel U, Kotz R, Ritter J, et al. Osteosarcoma of the trunk treated by multimodal therapy: experience of the Cooperative Osteosarcoma study group (COSS). Med Pediatr Oncol. 1995;24:6–12.

    Article  CAS  PubMed  Google Scholar 

  21. Antman K, Crowley J, Balcerzak SP, Kempf RA, Weiss RB, Clamon GH, et al. A Southwest Oncology Group and Cancer and Leukemia Group B phase II study of doxorubicin, dacarbazine, ifosfamide, and mesna in adults with advanced osteosarcoma, Ewing’s sarcoma, and rhabdomyosarcoma. Cancer. 1998;82:1288–95.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We thank H. Chuman, F. Nakatani, A. Hosono, (National Cancer Center Hospital), and H. Kiuchi (Chiba Cancer Center) for collecting clinical information. We would also like to thank A. Araki (Chiba Cancer Center), A. Yoshida (National Cancer Center Hospital), and M. Takagi (St. Marianne University) for reviewing histological diagnoses.

Disclosure

The authors declare that they have no conflict of interest.

Funding

None.

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Authors and Affiliations

  1. Division of Orthopedic Surgery, Chiba Cancer Center, Chuo-ku, Chiba, Japan

    Shintaro Iwata MD, Takeshi Ishii MD, Tsukasa Yonemoto MD & Hiroto Kamoda MD

  2. Division of Orthopaedic Surgery, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan

    Akira Kawai MD & Naofumi Asano MD

  3. Division of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Yokohama, Japan

    Toru Hiruma MD & Masanobu Takeyama MD

Authors
  1. Shintaro Iwata MD
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  2. Takeshi Ishii MD
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  3. Akira Kawai MD
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  4. Toru Hiruma MD
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  5. Tsukasa Yonemoto MD
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  6. Hiroto Kamoda MD
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  7. Naofumi Asano MD
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  8. Masanobu Takeyama MD
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Corresponding author

Correspondence to Shintaro Iwata MD.

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Iwata, S., Ishii, T., Kawai, A. et al. Prognostic Factors in Elderly Osteosarcoma Patients: A Multi-institutional Retrospective Study of 86 Cases. Ann Surg Oncol 21, 263–268 (2014). https://doi.org/10.1245/s10434-013-3210-4

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  • DOI: https://doi.org/10.1245/s10434-013-3210-4

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