Purpose: To assess the impact of several patient-related and treatment-related prognostic factors in patients with localized osteosarcoma of the extremities treated at a single institution with the same chemotherapy protocol over a three-year period.
Patients and Methods: We reviewed 57 patients with localized osteosarcoma of the extremities treated at the Children’s Cancer Hospital, Egypt, between July 2007 and December 2010, with a minimum follow-up of one year. Gender, age, tumor site and size, type of surgery, surgical margins, serum level of alkaline phosphatase and histologic response to preoperative treatment were retrospectively evaluated.
Results: With a median follow-up of 23 months, the three-year Event-Free Survival (EFS) and overall survival rates were 70.5% and 77.8 %, respectively. In univariate analysis, EFS was significantly related to the age of patients, serum level of alkaline phosphatase, and tumor volume but not to histologic subtype or histologic response to preoperative treatment. In multivariate analysis, only gender and serum alkaline phosphatase were statistically significant. Local and systemic recurrences occurred in 12 patients (21%) (10 developed pulmonary metastasis, one patient developed both bone and pulmonary metastases, and one patient had local recurrence). Median time to recurrence was 9.2 months, and recurrence correlated with the histologic response to preoperative treatment, tumor volume and serum alkaline phosphatase.
Conclusion: The three- year EFS and overall survival were 70.5% and 77.8%, respectively. Age, tumor volume, and the serum level of alkaline phosphatase significantly influenced EFS. These factors should be considered when deciding on risk-adapted treatments for osteosarcoma patients. However, gender and serum alkaline phosphatase were the only significant variables in the multivariate analysis
Manal A. Zamzam¹, Emad Ali H. Moussa², Ahmed El Ghoneimy³, Magdy El Sherbiny³, Mohamed S. Zagloul⁴, Hala Taha⁵, Iman Goda⁵, Sameera Ezzat⁶, and Ranin Soliman⁷*