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Proximal Tumor Location and Fluid-fluid Levels on MRI Predict Resistance to Chemotherapy in Stage IIB Osteosarcoma

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Primary tumor growth during neoadjuvant chemotherapy is believed to be a sign of resistance to chemotherapy (chemoresistance), and often is associated with poor histologic response, local recurrence, and poorer survival. Currently there are no proven indicators to predict poor response to chemotherapy at the time of diagnosis.

Questions/purposes

We asked (1) what clinicopathologic factors present at diagnosis predict primary tumor growth during neoadjuvant chemotherapy, (2) what factors at presentation predict survival, and (3) when the factors at presentation and the treatment-related factors are considered, what factors independently correlate with survival.

Methods

We studied 567 patients with Stage IIB osteosarcomas. The factors assessed included age, sex, location, pattern on plain radiographs (radiodense, radiolucent, mixed), MRI findings, pathologic subtype, initial tumor volume determined by MRI, tumor volume change after chemotherapy, surgical margin, and histologic response to preoperative chemotherapy. Logistic modeling was used to identify risk factors.

Results

Independent risk factors associated with primary tumor growth after neoadjuvant chemotherapy were proximal tumor location (p < 0.01; relative risk [RR], 2.41; 95% CI, 1.5–3.86) and fluid-fluid level on initial MRI (p < 0.01; RR, 5.56; 95% CI, 3.48–8.87). Among factors at presentation, large initial tumor volume (p < 0.01; RR, 1.58; 95% CI, 1.22–2.04), proximal tumor site (p < 0.01; RR, 1.61; 95% CI, 1.19–2.19), and presence of fluid-fluid level (p < 0.01; RR, 1.83; 95% CI, 1.37–2.5) independently predicted reduced event–free survival. When we consider the factors at presentation and treatment-related factors, large initial tumor volume (p < 0.01; RR, 1.54), tumor growth after neoadjuvant chemotherapy (p < 0.01; RR, 3.88), inadequate surgical margin (p < 0.01; RR, 2.42), and poor histologic response (p = 0.03; RR, 1.43) were independent poor prognostic factors of event-free survival.

Conclusions

Proximal tumor location and the presence of the fluid-fluid level on initial MRI were predictors of tumor progression and poor survival in patients presenting with Stage IIB osteosarcomas. If confirmed in other studies, patients with these risk factors should be considered for trials of other treatment strategy.

Level of Evidence

Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Min Suk Kim, MD and Jae Soo Koh, MD for review of the pathologic specimens.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu (75, Nowon-Ro, Nowon-Gu), Seoul, 139-706, Korea

    Dae-Geun Jeon MD, Won Seok Song MD, Wan Hyeong Cho MD, Chang-Bae Kong MD & Sang Hyun Cho MD

  2. Department of Orthopedic Surgery, Dongnam Institute of Radiological and Medical Science, Pusan, Korea

    Sang Hyun Cho MD

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  1. Dae-Geun Jeon MD
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  2. Won Seok Song MD
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  3. Wan Hyeong Cho MD
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Corresponding author

Correspondence to Dae-Geun Jeon MD.

Additional information

This work was supported by a grant of the Radiological Translational Research program, Korea Institute of Radiological & Medical Sciences (50471-2013)(D-GJ), Seoul, Korea.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Jeon, DG., Song, W.S., Cho, W.H. et al. Proximal Tumor Location and Fluid-fluid Levels on MRI Predict Resistance to Chemotherapy in Stage IIB Osteosarcoma. Clin Orthop Relat Res 472, 1911–1920 (2014). https://doi.org/10.1007/s11999-014-3521-1

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  • DOI: https://doi.org/10.1007/s11999-014-3521-1

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