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Skip metastases in high-grade intramedullary appendicular osteosarcoma: an indicator of more aggressive disease?

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Abstract

Objective

To determine whether skip metastases (SM) in high-grade appendicular osteosarcoma (HG-OS) are an indicator of more aggressive disease.

Materials and method

Retrospective review of patients with histologically confirmed diagnosis HG-OS of the long bones from 2007 to 2020, who had whole-bone MRI to identify SM. Data collected included patient age/gender, bone involved, the presence of SM, the presence of lung metastases from chest CT, the presence of distant bone metastases from whole-body bone scintigraphy or whole-body MRI, and chemotherapy response from resection specimen histology. The presence of lung or bone metastases and chemotherapy response were compared between patients without and with SM.

Results

The study included 241 patients (146 males; 95 females: mean age 18.2 years; range 4–73 years). Based on whole-bone MRI, 202 (83.8%) patients had no SM and 39 (16.2%) patients had a SM. Of patients without a SM, lung metastases were identified in 44 (22%) and distant bone metastases in 6 (3%) cases, while 80 (43%) had a good chemotherapy response and 105 (57%) had a poor chemotherapy response. Of patients with a SM, lung metastases were identified in 22 (58%) and distant bone metastases in 8 (21%) cases, while 11 (32%) had a good chemotherapy response and 23 (68%) had a poor chemotherapy response. The presence of SM was significantly associated with both lung metastases (p < 0.001) and skeletal metastases (p < 0.001), but not with chemotherapy response (p = 0.24). Patients with SM also had poorer survival (p < 0.001).

Conclusions

The presence of SM in appendicular HG-OS suggests more aggressive disease.

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Acknowledgements

The authors thank Mr. Paul Bassett for statistical input.

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Authors and Affiliations

  1. Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill Stanmore, HA7 4LP, Middlesex, UK

    Asif Saifuddin & Ian Pressney

  2. Department of Paediatric Oncology, University College Hospital, 250 Euston Road, London, NW1 2PG, UK

    Maria Michelagnoli

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  1. Asif Saifuddin
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  2. Maria Michelagnoli
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  3. Ian Pressney
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Correspondence to Ian Pressney.

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Saifuddin, A., Michelagnoli, M. & Pressney, I. Skip metastases in high-grade intramedullary appendicular osteosarcoma: an indicator of more aggressive disease?. Skeletal Radiol 50, 2415–2422 (2021). https://doi.org/10.1007/s00256-021-03814-8

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  • DOI: https://doi.org/10.1007/s00256-021-03814-8

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