Advertisement

Annals of Surgical Oncology

, Volume 23, Issue 1, pp 120–125 | Cite as

Metastatic Potential of Grade I Chondrosarcoma of Bone: Results of a Multi-institutional Study

  • Dimosthenis AndreouEmail author
  • Magdalena M. Gilg
  • Georg Gosheger
  • Mathias Werner
  • Jendrik Hardes
  • Daniel Pink
  • Andreas Leithner
  • Per-Ulf Tunn
  • Arne Streitbürger
Bone and Soft Tissue Sarcomas

Abstract

Background

Little is known about the metastatic potential of low-grade chondrosarcoma. This study was designed to evaluate the rate of metastasis to identify possible risk factors.

Methods

The files of 225 patients with newly diagnosed, grade I chondrosarcoma of bone treated between 1975 and 2012 were retrospectively analyzed. Median follow-up was 80 months for survivors (range 24–445 months). Nonparametric analyses were performed with the Mann–Whitney U test. Survival curves were calculated with the Kaplan–Meier method and compared with the log-rank test.

Results

Fourteen patients developed metastases after a median of 49 months. Metastasis-free survival probability (MFS) was 95 % at 5 years and 92 % at 10 years. Post-metastasis survival probability amounted to 27 % after 5 years. Tumor size at diagnosis (P = 0.698) and surgical margin width (P = 0.514) had no influence on MFS. Patients who developed local recurrences had a significantly lower 10-year MFS than patients without recurrences (69 % vs. 99 %, P < 0.001). Patients with grade I recurrences had a significantly poorer MFS than patients without recurrences (P = 0.013) but a significantly higher MFS than patients with grade II recurrences (P = 0.006). Patients with thoracic wall tumors had a significantly lower 10-year MFS of 66 % compared with patients with tumors of the upper (100 %, P < 0.001) and lower extremity (93 %, P = 0.033).

Conclusions

The biological behavior of low-grade chondrosarcoma appears to be more consistent with the WHO definition of rarely metastasizing bone tumors, rather than the one of locally aggressive neoplasms. Thoracic wall tumors and the development of local recurrences were associated with a higher metastasis rate in this study.

Keywords

Local Recurrence Chondrosarcoma Intralesional Curettage Follow Tumor Resection Extremity Tumor 
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.

Notes

Disclosure

The authors declare no conflict of interest.

References

  1. 1.
    Hogendoorn PCW, Bovée JVMG, Nielsen GP. Chondrosarcoma (grades I-III), including primary and secondary variants and periosteal chondrosarcoma. In: Fletcher C, Bridge J, Hogendoorn P, Mertens F, eds. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer; 2013.Google Scholar
  2. 2.
    Gelderblom H, Hogendoorn PC, Dijkstra SD, et al. The clinical approach towards chondrosarcoma. Oncologist. 2008;13(3):320–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Evans HL, Ayala AG, Romsdahl MM. Prognostic factors in chondrosarcoma of bone: a clinicopathologic analysis with emphasis on histologic grading. Cancer. 1977;40(2):818–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Bjornsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ. Primary chondrosarcoma of long bones and limb girdles. Cancer. 1998;83(10):2105–19.PubMedCrossRefGoogle Scholar
  5. 5.
    Andreou D, Ruppin S, Fehlberg S, Pink D, Werner M, Tunn PU. Survival and prognostic factors in chondrosarcoma: results in 115 patients with long-term follow-up. Acta Orthop. 2011;82(6):749–55.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Leerapun T, Hugate RR, Inwards CY, Scully SP, Sim FH. Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Rel Res. 2007;463:166–72.Google Scholar
  7. 7.
    Streitburger A, Ahrens H, Balke M, et al. Grade I chondrosarcoma of bone: the Munster experience. J Cancer Res Clin Oncol. 2009;135(4):543–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Funovics PT, Panotopoulos J, Sabeti-Aschraf M, et al. Low-grade chondrosarcoma of bone: experiences from the Vienna Bone and Soft Tissue Tumour Registry. Int Orthop. 2011;35(7):1049–56.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Hickey M, Farrokhyar F, Deheshi B, Turcotte R, Ghert M. A systematic review and meta-analysis of intralesional versus wide resection for intramedullary grade I chondrosarcoma of the extremities. Ann Surg Oncol. 2011;18(6):1705–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Verdegaal SH, Brouwers HF, van Zwet EW, Hogendoorn PC, Taminiau AH. Low-grade chondrosarcoma of long bones treated with intralesional curettage followed by application of phenol, ethanol, and bone-grafting. J Bone Joint Surg Am. 2012;94(13):1201–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Campanacci DA, Scoccianti G, Franchi A, et al. Surgical treatment of central grade 1 chondrosarcoma of the appendicular skeleton. J Orthop Traumatol. 2013;14(2):101–7.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Grimer RJ, Hogendoorn PCW, Vanel D. Tumours of bone: Introduction. In: Fletcher C, Bridge J, Hogendoorn P, Mertens F, eds. WHO classification of tumours of soft tissue and bone. Lyon: International Agency for Research on Cancer; 2013.Google Scholar
  13. 13.
    Rizzo M, Ghert MA, Harrelson JM, Scully SP. Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Rel Res. 2001(391):224–33.CrossRefGoogle Scholar
  14. 14.
    Kaplan E, Maier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–81.CrossRefGoogle Scholar
  15. 15.
    Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep Part 1. 1966;50(3):163–170.Google Scholar
  16. 16.
    Enneking WF. A system of staging musculoskeletal neoplasms. Clin Orthop Rel Res. 1986(204):9–24.Google Scholar
  17. 17.
    Skeletal Lesions Interobserver Correlation among Expert Diagnosticians Study Group. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89(10):2113–23.CrossRefGoogle Scholar
  18. 18.
    Eefting D, Schrage YM, Geirnaerdt MJ, et al. Assessment of interobserver variability and histologic parameters to improve reliability in classification and grading of central cartilaginous tumors. Am J Surg Pathol. 2009;33(1):50–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Schwab JH, Wenger D, Unni K, Sim FH. Does local recurrence impact survival in low-grade chondrosarcoma of the long bones? Clin Orthop Rel Res. 2007;462:175–80.CrossRefGoogle Scholar
  20. 20.
    Taminiau AHM, Bovée JVMG, van Rijswijk CSP, Gelderblom HAJ, van de Sande MAJ. Cartilage Tumours of Bone. In: Bentley G, ed. European surgical orthopaedics and traumatology the EFORT textbook. Berlin: Springer; 2014. doi: 10.1007/978-3-642-34746-7.Google Scholar
  21. 21.
    Berrington de Gonzalez A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Puri A, Gulia A, Hawaldar R, Ranganathan P, Badwe RA. Does intensity of surveillance affect survival after surgery for sarcomas? Results of a randomized noninferiority trial. Clin Orthop Rel Res. 2014;472(5):1568–75.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  1. 1.Department of General Orthopedics and Tumor OrthopedicsMünster University HospitalMünsterGermany
  2. 2.Department of Orthopedic SurgeryMedical University of GrazGrazAustria
  3. 3.Department of Pathology, Sarcoma Center Berlin-BrandenburgHELIOS Klinikum Emil von BehringBerlinGermany
  4. 4.Department of Hematology, Oncology and Palliative Care, Sarcoma Center Berlin-BrandenburgHELIOS Klinikum Bad SaarowBad SaarowGermany
  5. 5.Department of Orthopedic Oncology, Sarcoma Center Berlin-BrandenburgHELIOS Klinikum Berlin-BuchBerlinGermany

Personalised recommendations