Clinical Orthopaedics and Related Research®

, Volume 471, Issue 3, pp 784–791 | Cite as

Making a Case for the Socioeconomic Determinacy of Survival in Osteosarcoma

  • Saminathan S. NathanEmail author
  • John H. Healey
Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing, China



The literature on osteosarcoma survival generally focuses on tumor and treatment variables, although it is unclear whether and how ethnic and socioeconomic factors might influence survival.


We therefore investigated the relative contribution of socioeconomic influences together with more traditional tumor-specific factors on osteosarcoma survival.


We performed survival analyses on two national databases in two countries. Using multivariable analyses, we compared these with corresponding institution-specific survival to determine if socioeconomic factors might impact osteosarcoma survival.


East Asian descent, state-specific treatment, female sex, treatment in the 1990s, low-grade disease, intracompartmental disease, small size, wide resections as opposed to forequarter or hindquarter amputations, and single primaries were good prognostic factors. Survival was better in the more affluent states. Males were affected at an older age than females. Blacks tended to have larger tumors, although their overall survival was similar to whites. East Asians were more likely to be treated in the 1990s with wide resections for smaller tumors and were located around states associated with good treatment. East Asians in Singapore and the United States had the same survival. Survival in East Asians in Singapore was similar to that of other races. The provision of health care for osteosarcoma varies greatly across the United States but is uniform in the socialized medical system in Singapore. Hence, the observed differences in the United States were likely the result of socioeconomic factors.


Our analysis suggests ethnic and economic bias may influence survival in osteosarcoma and should receive greater attention in the collective literature on survival analyses.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.


Osteosarcoma Wide Resection Major Amputation Affluent State Chondroblastic Osteosarcoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We express our gratitude to Elyn R. Riedel, Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, for her invaluable assistance in statistical analysis.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  1. 1.Department of OrthopaedicsNational University of Singapore Yong Loo Lin School of Medicine SingaporeSingapore
  2. 2.Orthopaedic Surgery Service, Department of SurgeryMemorial Sloan-Kettering Cancer Center, Affiliated with Weill Medical College of Cornell UniversityNew YorkUSA

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