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The relation of tumour necrosis and survival in patients with osteosarcoma

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Abstract

Purpose

We investigated whether tumour necrosis was associated with disease-free survival (DFS) and overall survival (OS) of osteosarcoma patients treated in our institution.

Methods

We retrospectively studied the predictive value of percentage of necrosis in 40 cases of IIB osteosarcoma treated from 1999 to 2008 in our institution. Patient and treatment factors such as age, gender, tumour site, surgery type, pathological type, tumour size, margin status, percentage of tumour necrosis, chemotherapy regimens and cycles were recorded. The average follow-up was 85.9 months (range, 25–135 months).

Results

Two patients had local recurrence (LR) alone, five patients had both LR and metastasis, 14 patients had metastasis alone. Twenty-four patients were alive and 16 had died. The five-year DFS and OS were 47.8% and 65.9%, respectively. Tumour necrosis grouped by 90% was not associated with DFS and OS. Patients with greater than 70% necrosis rate had a significantly higher DFS than those with less than 70%.

Conclusion

We found no survival advantage at 90% tumour necrosis in our study. Further study with more patients should be performed to evaluate the predictive value of necrosis rate at the cutoff of 70%.

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References

  1. Carrle D, Bielack SS (2006) Current strategies of chemotherapy in osteosarcoma. Int Orthop 30:445–451

    Article  PubMed  Google Scholar 

  2. Bacci G, Longhi A, Versari M, Mercuri M, Briccoli A, Picci P (2006) Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15-year experience in 789 patients treated at a single institution. Cancer 106:1154–1161

    Article  PubMed  Google Scholar 

  3. Ferrari S, Bacci G, Picci P, Mercuri M, Briccoli A, Pinto D, Gasbarrini A, Tienghi A, Brach del Prever A (1997) Long-term follow-up and post-relapse survival in patients with non-metastatic osteosarcoma of the extremity treated with neoadjuvant chemotherapy. Ann Oncol 8:765–771

    Article  PubMed  CAS  Google Scholar 

  4. Ford S, Saithna A, Grimer RJ, Picci P (2004) Comparison of the outcome of conventional osteosarcoma at two specialist international orthopaedic oncology centres. Sarcoma 8:13–18

    Article  PubMed  Google Scholar 

  5. Pakos EE, Nearchou AD, Grimer RJ, Koumoullis HD, Abudu A, Bramer JA, Jeys LM, Franchi A, Scoccianti G, Campanacci D, Capanna R, Aparicio J, Tabone MD, Holzer G, Abdolvahab F, Funovics P, Dominkus M, Ilhan I, Berrak SG, Patino-Garcia A, Sierrasesumaga L, San-Julian M, Garraus M, Petrilli AS, Filho RJ, Macedo CR, Alves MT, Seiwerth S, Nagarajan R, Cripe TP, Ioannidis JP (2009) Prognostic factors and outcomes for osteosarcoma: an international collaboration. Eur J Cancer 45:2367–2375

    Article  PubMed  Google Scholar 

  6. Bacci G, Bertoni F, Longhi A, Ferrari S, Forni C, Biagini R, Bacchini P, Donati D, Manfrini M, Bernini G, Lari S (2003) Neoadjuvant chemotherapy for high-grade central osteosarcoma of the extremity. Histologic response to preoperative chemotherapy correlates with histologic subtype of the tumor. Cancer 97:3068–3075

    Article  PubMed  CAS  Google Scholar 

  7. Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jürgens H, Winkler K (2002) Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 20:776–790

    Article  PubMed  Google Scholar 

  8. Bacci G, Longhi A, Bertoni F, Bacchini P, Ruggeri P, Versari M, Picci P (2005) Primary high-grade osteosarcoma: comparison between preadolescent and older patients. J Pediatr Hematol Oncol 27:129–134

    Article  PubMed  Google Scholar 

  9. Lee JA, Kim DH, Lim JS, Park KD, Song WS, Lee SY, Jeon DG (2007) The survival of osteosarcoma patients 10 years old or younger is not worse than the survival of older patients: a retrospective analysis. Cancer Res Treat 39:160–164

    Article  PubMed  Google Scholar 

  10. Baldini N, Scotlandi K, Barbanti-Bròdano G, Manara MC, Maurici D, Bacci G, Bertoni F, Picci P, Sottili S, Campanacci M, Serra M (1995) Expression of P-glycoprotein in high-grade osteosarcomas in relation to clinical outcome. N Engl J Med 333:1380–1385

    Article  PubMed  CAS  Google Scholar 

  11. Bacci G, Mercuri M, Longhi A, Ferrari S, Bertoni F, Versari M, Picci P (2005) Grade of chemotherapy-induced necrosis as a predictor of local and systemic control in 881 patients with non-metastatic osteosarcoma of the extremities treated with neoadjuvant chemotherapy in a single institution. Eur J Cancer 41:2079–2085

    Article  PubMed  CAS  Google Scholar 

  12. Bacci G, Briccoli A, Ferrari S, Longhi A, Mercuri M, Capanna R, Donati D, Lari S, Forni C, DePaolis M (2001) Neoadjuvant chemotherapy for osteosarcoma of the extremity: long-term results of the Rizzoli's 4th protocol. Eur J Cancer 37:2030–2039

    Article  PubMed  CAS  Google Scholar 

  13. Le Deley MC, Guinebretière JM, Gentet JC, Pacquement H, Pichon F, Marec-Bérard P, Entz-Werlé N, Schmitt C, Brugières L, Vanel D, Dupoüy N, Tabone MD, Kalifa C (2007) SFOP OS94: a randomised trial comparing preoperative high-dose methotrexate plus doxorubicin to high-dose methotrexate plus etoposide and ifosfamide in osteosarcoma patients. Eur J Cancer 43:752–761

    Article  PubMed  Google Scholar 

  14. Lewis IJ, Nooij MA, Whelan J, Sydes MR, Grimer R, Hogendoorn PC, Memon MA, Weeden S, Uscinska BM, van Glabbeke M, Kirkpatrick A, Hauben EI, Craft AW, Taminiau AH (2007) Improvement in histologic response but not survival in osteosarcoma patients treated with intensified chemotherapy: a randomized phase III trial of the European Osteosarcoma Intergroup. J Natl Cancer Inst 99:112–128

    Article  PubMed  CAS  Google Scholar 

  15. Harting MT, Lally KP, Andrassy RJ, Vaporciyan AA, Cox CS Jr, Hayes-Jordan A, Blakely ML (2010) Age as a prognostic factor for patients with osteosarcoma: an analysis of 438 patients. J Cancer Res Clin Oncol 136:561–570

    Article  PubMed  Google Scholar 

  16. Smeland S, Müller C, Alvegard TA, Wiklund T, Wiebe T, Björk O, Stenwig AE, Willén H, Holmström T, Follerås G, Brosjö O, Kivioja A, Jonsson K, Monge O, Saeter G (2003) Scandinavian Sarcoma Group Osteosarcoma Study SSG VIII: prognostic factors for outcome and the role of replacement salvage chemotherapy for poor histological responders. Eur J Cancer 39:488–494

    Article  PubMed  CAS  Google Scholar 

  17. Bacci G, Ferrari S, Bertoni F, Ruggieri P, Picci P, Longhi A, Casadei R, Fabbri N, Forni C, Versari M, Campanacci M (2000) Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the Istituto Ortopedico Rizzoli according to the Istituto Ortopedico Rizzoli/osteosarcoma-2 protocol: an updated report. J Clin Oncol 18:4016–4027

    PubMed  CAS  Google Scholar 

  18. Ferrari S, Bertoni F, Mercuri M, Picci P, Giacomini S, Longhi A, Bacci G (2001) Predictive factors of disease-free survival for non-metastatic osteosarcoma of the extremity: an analysis of 300 patients treated at the Rizzoli Institute. Ann Oncol 12:1145–1150

    Article  PubMed  CAS  Google Scholar 

  19. Iwamoto Y, Tanaka K, Isu K, Kawai A, Tatezaki S, Ishii T, Kushida K, Beppu Y, Usui M, Tateishi A, Furuse K, Minamizaki T, Kawaguchi N, Yamawaki S (2009) Multiinstitutional phase II study of neoadjuvant chemotherapy for osteosarcoma (NECO study) in Japan: NECO-93 J and NECO-95 J. J Orthop Sci 14:397–404

    Article  PubMed  CAS  Google Scholar 

  20. Rosen G, Caparros B, Huvos AG, Kosloff C, Nirenberg A, Cacavio A, Marcove RC, Lane JM, Mehta B, Urban C (1982) Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer 49:1221–1230

    Article  PubMed  CAS  Google Scholar 

  21. Salzer-Kuntschik M, Brand G, Delling G (1983) Determination of the degree of morphological regression following chemotherapy in malignant bone tumors. Pathologe 4:135–141

    PubMed  CAS  Google Scholar 

  22. Bielack SS, Machatschek JN, Flege S, Jürgens H (2004) Delaying surgery with chemotherapy for osteosarcoma of the extremities. Expert Opin Pharmacother 5:1243–1256

    Article  PubMed  Google Scholar 

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Acknowledgement

We thank Linda D. Pickron for assistance with collecting all the medical charts for this research.

Conflict of interest

One of the authors (X.L.) received funding in the form of a visiting scholarship from China Scholarship Council. Two of the authors (V.M.M. and A.O.A.) received funding in the form of a research fellowship from Stryker Orthopaedics, Mahwah, NJ. One of the authors (R.D.L.) is a consultant for Stryker Orthopaedics, Mahwah, NJ.

Each author certifies that his or her institution has approved or waived approval for the human protocol for this investigation and that all investigators were conducted in conformity with ethical principles for research. This study was approved by the Institutional Review Board.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Qilu Hospital of Shandong University, 107 Wen Hua Xi Road, Jinan, Shandong, China, 250012

    Xin Li

  2. Department of Orthopaedic Surgery, University of Pennsylvania, Garfield Duncan Building, Suite 2C, 30S.8th Street, Philadelphia, PA, 19106-6192, USA

    Adedayo O. Ashana, Vincent M. Moretti & Richard D. Lackman

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  1. Xin Li
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  2. Adedayo O. Ashana
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  3. Vincent M. Moretti
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  4. Richard D. Lackman
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Correspondence to Richard D. Lackman.

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Li, X., Ashana, A.O., Moretti, V.M. et al. The relation of tumour necrosis and survival in patients with osteosarcoma. International Orthopaedics (SICOT) 35, 1847–1853 (2011). https://doi.org/10.1007/s00264-011-1209-7

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  • DOI: https://doi.org/10.1007/s00264-011-1209-7

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