Skip to main content
SpringerLink
Log in

Osteosarcoma: improvement in survival limited to high-grade patients only

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

We sought to identify the significant prognostic parameters of patients with osteosarcoma over the past three decades using a population-based registry.

Methods

A total of 3765 patients with osteosarcoma were identified in the SEER database. Information regarding patient demographics, clinical and treatment characteristics, cause of death and survival were extracted. Kaplan–Meier, Log-Rank, and Cox regression were used for analysis.

Results

On multivariate analysis only age group ‘<25 years’, ‘local’ stage and ‘low’ grade, ‘appendicular skeleton’ and employment of ‘surgical resection’ showed a disease-specific survival benefit with a P value < 0.001. The long-term survival improved in the interval from 1973 to 1985 from approximately 55 to 65% but subsequent improvement has been limited only to patients with high-grade disease.

Conclusion

When comparing survival rates by decade of diagnosis, it appears that improvement in survival since 1985 is limited to patients with high-grade disease only.

Level of evidence

The level of evidence for this article is 2.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  • Arndt CA, Crist WM (1999) Common musculoskeletal tumors of childhood and adolescence. N Engl J Med 341:342–352

    Article  PubMed  CAS  Google Scholar 

  • Bacci G, Picci P, Ferrari S, Orlandi M, Ruggieri P, Casadei R, Ferraro A, Biagini R, Battistini A (1993) Prognostic significance of serum alkaline phosphatase measurements in patients with osteosarcoma treated with adjuvant or neoadjuvant chemotherapy. Cancer 71:1224–1230

    Article  PubMed  CAS  Google Scholar 

  • Bacci G, Ferrari S, Sangiorgi L, Picci P, Casadei R, Orlandi M, Iantorno D, Battistini A, Zanone A (1994) Prognostic significance of serum lactate dehydrogenase in patients with osteosarcoma of the extremities. J Chemother 6:204–210

    PubMed  CAS  Google Scholar 

  • 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 

  • Bacci G, Forni C, Longhi A, Ferrari S, Mercuri M, Bertoni F, Serra M, Briccoli A, Balladelli A, Picci P (2007) Local recurrence and local control of non-metastatic osteosarcoma of the extremities: a 27-year experience in a single institution. J Surg Oncol 96:118–123

    Article  PubMed  Google Scholar 

  • Bach PB, Guadagnoli E, Schrag D, Schussler N, Warren JL (2002) Patient demographic and socioeconomic characteristics in the SEER-Medicare database applications and limitations. Med Care 40:IV-19-25

    Google Scholar 

  • Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W et al (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 

  • Bieling P, Rehan N, Winkler P, Helmke K, Maas R, Fuchs N, Bielack S, Heise U, Jurgens H, Treuner J et al (1996) Tumor size and prognosis in aggressively treated osteosarcoma. J Clin Oncol 14:848–858

    PubMed  CAS  Google Scholar 

  • Bramwell VH, Burgers M, Sneath R, Souhami R, van Oosterom AT, Voute PA, Rouesse J, Spooner D, Craft AW, Somers R et al (1992) A comparison of two short intensive adjuvant chemotherapy regimens in operable osteosarcoma of limbs in children and young adults: the first study of the European Osteosarcoma Intergroup. J Clin Oncol 10:1579–1591

    PubMed  CAS  Google Scholar 

  • Carsi B, Rock MG (2002) Primary osteosarcoma in adults older than 40 years. Clin Orthop Relat Res 53–61

  • Cheung MC, Perez EA, Molina MA, Jin X, Gutierrez JC, Franceschi D, Livingstone AS, Koniaris LG (2008) Defining the role of surgery for primary gastrointestinal tract melanoma. J Gastrointest Surg 12:731–738

    Article  PubMed  Google Scholar 

  • Clark JC, Dass CR, Choong PF (2008) A review of clinical and molecular prognostic factors in osteosarcoma. J Cancer Res Clin Oncol 134:281–297

    Article  PubMed  CAS  Google Scholar 

  • Cooper GS, Virnig B, Klabunde CN, Schussler N, Freeman J, Warren JL (2002) Use of SEER-Medicare data for measuring cancer surgery. Med Care 40:IV-43-48

    Google Scholar 

  • Cortes EP et al (1972) Doxorubicin in disseminated Osteosarcoma. JAMA 221:1132–1138

    Article  Google Scholar 

  • Damron TA, Ward WG, Stewart A (2007) Osteosarcoma, chondrosarcoma, and Ewing’s sarcoma: National Cancer Data Base Report. Clin Orthop Relat Res 459:40–47

    Article  PubMed  Google Scholar 

  • Davis AM, Bell RS, Goodwin PJ (1994) Prognostic factors in osteosarcoma: a critical review. J Clin Oncol 12:423–431

    PubMed  CAS  Google Scholar 

  • Dupuytren G (1805) Tumors of bone. Bull Ecole Med de Paris 13–24

  • Earle CC, Nattinger AB, Potosky AL, Lang K, Mallick R, Berger M, Warren JL (2002) Identifying cancer relapse using SEER-Medicare data. Med Care 40:IV-75–81

    Google Scholar 

  • French Bone Tumor Study Group (1988) Age and dose of chemotherapy as major prognostic factors in a trial of adjuvant therapy of osteosarcoma combining two alternating drug combinations and early prophylactic lung irradiation. Cancer 61:1304–1311

    Google Scholar 

  • Gloeckler Ries LA, Reichman ME, Lewis DR, Hankey BF, Edwards BK (2003) Cancer survival and incidence from the Surveillance, Epidemiology, and End Results (SEER) program. Oncologist 8:541–552

    Article  PubMed  Google Scholar 

  • Goorin AM, Perez-Atayde A, Gebhardt M, Andersen JW, Wilkinson RH, Delorey MJ, Watts H, Link M, Jaffe N, Frei E III et al (1987) Weekly high-dose methotrexate and doxorubicin for osteosarcoma: the Dana-Farber Cancer Institute/the Children’s Hospital—study III. J Clin Oncol 5:1178–1184

    PubMed  CAS  Google Scholar 

  • Gross SW (1879) Sarcoma of the long bones. Am J Med Sci 2–57

  • Gutierrez JC, Fischer AC, Sola JE, Perez EA, Koniaris LG (2007a) Markedly improving survival of neuroblastoma: a 30-year analysis of 1, 646 patients. Pediatr Surg Int 23:637–646

    Article  PubMed  Google Scholar 

  • Gutierrez JC, Perez EA, Franceschi D, Moffat FL Jr, Livingstone AS, Koniaris LG (2007b) Outcomes for soft-tissue sarcoma in 8249 cases from a large state cancer registry. J Surg Res 141:105–114

    Article  PubMed  Google Scholar 

  • Hayat MJ, Howlader N, Reichman ME, Edwards BK (2007) Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. Oncologist 12:20–37

    Article  PubMed  Google Scholar 

  • Hendershot E, Pappo A, Malkin D, Sung L (2006) Tumor necrosis in pediatric osteosarcoma: impact of modern therapies. J Pediatr Oncol Nurs 23:176–181

    Article  PubMed  Google Scholar 

  • Hwang JE, Cho SH, Kim OK, Shim HJ, Lee SR, Ahn JS, Yang DH, Kim YK, Lee JJ, Kim HJ, Chung IJ (2008) Newly developed multiple myeloma in a patient with primary T-cell lymphoma of bone. J Korean Med Sci 23:544–547

    Article  PubMed  Google Scholar 

  • Institute NC (2008) Surveillance, epidemiology and end results (SEER) Program

  • Jaffe N, Paed D, Farber S, Traggis D, Geiser C, Kim BS, Das L, Frauenberger G, Djerassi I, Cassady JR (1973) Favorable response of metastatic osteogenic sarcoma to pulse high-dose methotrexate with citrovorum rescue and radiation therapy. Cancer 31:1367–1373

    Article  PubMed  CAS  Google Scholar 

  • Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP (2009a) Ewing’s sarcoma demonstrates racial disparities in incidence and gender related difference in outcome: an analysis of 1631 cases from the SEER database (1973–2005). Cancer 115(15):3526–3536

    Google Scholar 

  • Jawad MU, Extein J, Min ES, Scully SP (2009b) Prognostic factors for survival in patients with epithelioid sarcoma: 441 cases from the SEER database. Clin Orthop Relat Res 467(11):2939–2948

    Google Scholar 

  • Jeon DG, Lee SY, Cho WH, Song WS, Park JH (2006) Primary osteosarcoma in patients older than 40 years of age. J Korean Med Sci 21:715–718

    Article  PubMed  Google Scholar 

  • Kim MS, Lee SY, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Jeon DG (2008) Tumor necrosis rate adjusted by tumor volume change is a better predictor of survival of localized osteosarcoma patients. Ann Surg Oncol 15:906–914

    Article  PubMed  Google Scholar 

  • Mankin HJ, Hornicek FJ, Rosenberg AE, Harmon DC, Gebhardt MC (2004) Survival data for 648 patients with osteosarcoma treated at one institution. Clin Orthop Relat Res 286–291

  • Merrill RM, Dearden KA (2004) How representative are the surveillance, epidemiology, and end results (SEER) program cancer data of the United States? Cancer Causes Control 15:1027–1034

    Article  PubMed  Google Scholar 

  • Meyers PA, Heller G, Healey J, Huvos A, Lane J, Marcove R, Applewhite A, Vlamis V, Rosen G (1992) Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol 10:5–15

    PubMed  CAS  Google Scholar 

  • Meyers PA, Schwartz CL, Krailo MD, Healey JH, Bernstein ML, Betcher D, Ferguson WS, Gebhardt MC, Goorin AM, Harris M et al (2008) Osteosarcoma: the addition of muramyl tripeptide to chemotherapy improves overall survival—a report from the Children’s Oncology Group. J Clin Oncol 26:633–638

    Article  PubMed  CAS  Google Scholar 

  • Mirabello L, Troisi RJ, Savage SA (2009) Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer 115:1531–1543

    Article  PubMed  Google Scholar 

  • NCI (2000) SEER summary staging manual http://seer.cancer.gov/tools/ssm/

  • Perez EA, Livingstone AS, Franceschi D, Rocha-Lima C, Lee DJ, Hodgson N, Jorda M, Koniaris LG (2006) Current incidence and outcomes of gastrointestinal mesenchymal tumors including gastrointestinal stromal tumors. J Am Coll Surg 202:623–629

    Article  PubMed  Google Scholar 

  • Perez EA, Gutierrez JC, Jin X, Lee DJ, Rocha-Lima C, Livingstone AS, Franceschi D, Koniaris LG (2007) Surgical outcomes of gastrointestinal sarcoma including gastrointestinal stromal tumors: a population-based examination. J Gastrointest Surg 11:114–125

    Article  PubMed  Google Scholar 

  • Petrelli NJ (2007) SEER data: it can be thought provoking, but where do we go from here? Ann Surg Oncol 14:2173–2174

    Article  PubMed  Google Scholar 

  • Potosky AL, Warren JL, Riedel ER, Klabunde CN, Earle CC, Begg CB (2002) Measuring complications of cancer treatment using the SEER-Medicare data. Med Care 40:IV-62–68

    Google Scholar 

  • Prindull G (1979) Multidrug chemotherapy of osteogenic sarcoma (author’s transl). Blut 39:293–300

    Article  PubMed  CAS  Google Scholar 

  • Provisor AJ, Ettinger LJ, Nachman JB, Krailo MD, Makley JT, Yunis EJ, Huvos AG, Betcher DL, Baum ES, Kisker CT, Miser JS (1997) Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children’s Cancer Group. J Clin Oncol 15:76–84

    PubMed  CAS  Google Scholar 

  • Saeter G, Elomaa I, Wahlqvist Y, Alvegard TA, Wiebe T, Monge O, Forrestier E, Solheim OP (1997) Prognostic factors in bone sarcomas. Acta Orthop Scand Suppl 273:156–160

    PubMed  CAS  Google Scholar 

  • Sami SH, Rafati AH, Hodjat P (2008) Tissue necrosis after chemotherapy in osteosarcoma as the important prognostic factor. Saudi Med J 29:1124–1129

    PubMed  Google Scholar 

  • Schrag D, Bach PB, Dahlman C, Warren JL (2002) Identifying and measuring hospital characteristics using the SEER-Medicare data and other claims-based sources. Med Care 40:IV-96–103

    Google Scholar 

  • Solheim OP, Saeter G, Elomaa I, Alvegard TA (1992) The treatment of osteosarcoma: present trends. The Scandinavian Sarcoma Group experience. Ann Oncol 3(Suppl 2):S7–S11

    Google Scholar 

  • Szendroi M, Papai Z, Koos R, Illes T (2000) Limb-saving surgery, survival, and prognostic factors for osteosarcoma: the Hungarian experience. J Surg Oncol 73:87–94

    Article  PubMed  CAS  Google Scholar 

  • Virnig BA, Warren JL, Cooper GS, Klabunde CN, Schussler N, Freeman J (2002) Studying radiation therapy using SEER-Medicare-linked data. Med Care 40:IV-49–54

    Google Scholar 

  • Warren JL, Harlan LC, Fahey A, Virnig BA, Freeman JL, Klabunde CN, Cooper GS, Knopf KB (2002a) Utility of the SEER-Medicare data to identify chemotherapy use. Med Care 40:IV-55–61

  • Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF (2002b) Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 40:IV-3–18

    Google Scholar 

  • Wingo PA, Jamison PM, Hiatt RA, Weir HK, Gargiullo PM, Hutton M, Lee NC, Hall HI (2003) Building the infrastructure for nationwide cancer surveillance and control—a comparison between the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) Program (United States). Cancer Causes Control 14:175–193

    Article  PubMed  Google Scholar 

  • Zalupski MM, Rankin C, Ryan JR, Lucas DR, Muler J, Lanier KS, Budd GT, Biermann JS, Meyers FJ, Antman K (2004) Adjuvant therapy of osteosarcoma—a Phase II trial: Southwest Oncology Group study 9139. Cancer 100:818–825

    Article  PubMed  CAS  Google Scholar 

Download references

Competing Interests

None of the authors has any competing interest with this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, University of Miami Miller School of Medicine, University of Miami Hospital, 4th Floor, 1400 NW, 12th Avenue, Miami, FL, 33136, USA

    Muhammad Umar Jawad & Sean P. Scully

  2. DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, 3550 Sylvester Comprehensive Cancer Center, 1475 NW, 12th Avenue, Miami, FL, 33136, USA

    Michael C. Cheung & Leonidas G. Koniaris

  3. Department of Epidemiology and Public Health, Clinical Research Building, University of Miami Miller School of Medicine, 1120 NW, 14th Street, Room 1005, Miami, FL, 33136, USA

    Jennifer Clarke

Authors
  1. Muhammad Umar Jawad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael C. Cheung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jennifer Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leonidas G. Koniaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sean P. Scully
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean P. Scully.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jawad, M.U., Cheung, M.C., Clarke, J. et al. Osteosarcoma: improvement in survival limited to high-grade patients only. J Cancer Res Clin Oncol 137, 597–607 (2011). https://doi.org/10.1007/s00432-010-0923-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-010-0923-7

Keywords

Search

Navigation