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Survival analysis of patients with metastatic osteosarcoma: a Surveillance, Epidemiology, and End Results population-based study

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Abstract

Purpose

The present study is aimed at investigating whether (1) primary tumour surgery confers an improved survival on patients with metastatic osteosarcoma and (2) primary tumour surgery influences survival of patients with metastatic osteosarcoma differently according to primary tumour site.

Methods

We retrospectively identified 517 patients with high-grade, metastatic osteosarcoma in the Surveillance, Epidemiology, and End Results (SEER) database between 1994 and 2013. The effect of primary tumour surgery on survival was assessed using Kaplan-Meier analyses, log-rank tests, and multivariate Cox proportional hazard regression modeling.

Results

Of those 517 patients with metastatic osteosarcoma in the cohort, 351 patients (68%) underwent primary surgery, and 166 patients (32%) did not undergo surgery. Primary tumour surgery was associated with increased overall survival (hazard ratio (HR) = 0.457, 95% CI 0.354–0.590, p < 0.001) and cancer-specific survival (HR = 0.422, 95% CI 0.325–0.550, p < 0.001). When we focused on different primary tumour sites, receipt of primary tumour surgery significantly prolonged the survival of patients with extremity osteosarcoma (p < 0.05 for overall and cancer-specific survival). However, for patients with pelvis/spine osteosarcoma, both univariate and multivariate analyses indicated that primary tumour surgery might not be associated with improved survival (p > 0.05 for overall and cancer-specific survival).

Conclusions

Our study is the first population-based analysis to provide evidence of a favourable prognostic impact of primary tumour surgery on metastatic extremity osteosarcoma patients but not metastatic axial (pelvis/spine) osteosarcoma patients. Moreover, we found that surgery type (resection of the primary tumor without amputation vs. amputation) did not influence survival in patients with metastatic osteosarcoma.

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Author notes

  1. Kehan Song, Jian Song and Kaiyuan Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Kehan Song & Feng Li

  2. Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China

    Kehan Song, Jian Song, Feiyan Chen, Xiaosheng Ma & Jianyuan Jiang

  3. Department of Orthopedic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

    Kaiyuan Lin

Authors
  1. Kehan Song
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  2. Jian Song
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  4. Feiyan Chen
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  5. Xiaosheng Ma
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  7. Feng Li
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Corresponding authors

Correspondence to Jianyuan Jiang or Feng Li.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Because we obtain data from the SEER database with open access, we did not need to acquire patient consent or an ethical review committee statement, but we were required to sign a Data Use Agreement for the SEER 1973–2014 Research Data File to gain access to the SEER database.

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Song, K., Song, J., Lin, K. et al. Survival analysis of patients with metastatic osteosarcoma: a Surveillance, Epidemiology, and End Results population-based study. International Orthopaedics (SICOT) 43, 1983–1991 (2019). https://doi.org/10.1007/s00264-019-04348-4

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  • DOI: https://doi.org/10.1007/s00264-019-04348-4

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