Management of high-grade bone sarcomas over two decades: The Norwegian Radium Hospital experience

Figures & data

Table I.  Patient characteristics.

	1980–89 (n = 144)	1990–99 (n = 108)
Osteosarcoma/MFH^1
Osteosarcoma	102	70
MFH	14	10
M/F ratio	2.31	0.95
Median age	23 (6–85)	25 (11–87)
Extremity tumours	76%	65%
Median tumour size (cm)	10 (2–33)	11 (3–30)
Metastatic disease^3	27%	24%
Symptom duration (months)	3 (0–23)	4 (0–96)
Inclusion in trial	28%	30%
Ewing sarcoma/PNET^2
Ewing's sarcoma	26	25
PNET	2	3
M/F ratio	1.33	1.55
Median age	15 (2–39)	20 (2–37)
Extremity tumours	46%	36%
Median tumour size (cm)	10 (4–30)	10 (3–27)
Metastatic disease^3	11%	32%
Symptom duration (months)	6 (1–26)	6 (0–24)
Inclusion in trial	57%	71%

¹Malignant fibrous histiocytoma.

²Primitive neuroectodermal tumour.

³At the time of diagnosis.

Table II.  Treatment of non-metastatic osteosarcoma/MFH (n = 146) and Ewing family of tumours (n = 44).

	1980–89 O = 85, E = 25	1990–99 O = 61, E = 19	Total O = 146, E = 44	p-value
Local treatment
Surgery(alone)	69%	75%	72%	NS^1
Osteosarcoma/MFH	82%	79%	81%	NS
Ewing family	24%	63%	41%	0.009
RT^2 (alone)	15%	4%	10%	0.014
Osteosarcoma/MFH	7%	5%	6%	NS
Ewing family	40%	0%	23%	0.002
Surgery + RT	15%	13%	14%	NS
Osteosarcoma/MFH	9%	7%	6%	NS
Ewing family	32%	32%	32%	NS
Amputation^3	69%	25%	54%	<0.001
Osteosarcoma/MFH	75%	26%	58%	<0.001
Ewing family	25%	20%	23%	NS
Systemic treatment
Chemotherapy	78%	83%	80%	NS
Osteosarcoma/MFH	72%	79%	75%	NS
Ewing family	100%	95%	98%	NS

¹Not statistically significant.

²Radiotherapy.

³Of extremity tumours.

Figure 1.  Sarcoma specific survival for all patients by period of diagnosis.

Figure 2.  Sarcoma specific survival for non-metastatic osteosarcoma and Ekring's sarcoma by period of diagnosis.

Table III.  Development over time in five-year sarcoma-specific survival in different patient and tumour categories.

		No. patients	Diagnosis 1980–1989 % survival	Diagnosis 1990–1999 % survival	Log Rank p
Tumour type	Osteosarcoma	196	39	46	0.35
	Ewing family	56	36	71	0.006
Stage	Localized	190	44	61	0.06
	Metastatic	62	21	29	0.13
Sex	Males	153	37	54	0.06
	Females	99	42	52	0.26
Age	≤40	188	46	60	0.04
	>40	64	15	35	0.06
Tumour site	Extremity	163	44	61	0.05
	Non-extremity	89	26	41	0.09
Tumour size	≤10 cm	101	47	64	0.17
	>10 cm	94	43	41	0.81
Inclusion in trial	Yes	93	61	66	0.73
	No	159	27	44	0.03

Table IV.  Favourable prognostic factors for sarcoma specific survival (195 OS and ES patients with complete data).

	Univariate analysis			Multivariate analysis
	HR^1	95% CI^2	p	HR	95% CI	p
Age ≤ 40 at diagnosis	0.37	0.27–0.52	<0.001	0.42	0.26–0.67	<0.001
Non-metastatic disease	0.43	0.31–0.60	<0.001	0.47	0.29–0.75	0.001
Extremity tumour	0.59	0.43–0.80	<0.001	0.50	0.33–0.75	0.001
Decreasing tumour size^3	0.94	0.91–0.97	<0.001	0.96	0.93–0.99	0.006
Diagnosis ≥ 1990	0.69	0.50–0.97	0.03	0.70	0.47–1.05	0.08
Diagnosis ≥ 1995^4	0.65	0.42–1.00	0.05	0.51	0.31–0.83	0.007
In prospective trial	0.39	0.27–0.56	<0.001	0.66	0.41–1.08	0.09
High chemotherapy intensity	0.53	0.37–0.78	0.01	0.88	0.50–1.52	0.64
Ewing tumour	0.65	0.43–0.98	0.04	0.83	0.43–1.59	0.57
Female sex	0.87	0.63–1.20	0.42	–	–	–
Symptom duration ≤ 6 months	0.87	0.56–1.37	0.55	–	–	–

¹Hazards ratio.

²Confidence interval.

³Analysed as a continuous variable where the HR indicates the decrease in risk for each cm of decrease in size.

⁴Altering the diagnostic periods did not affect the order or significance level of the other factors in the multivariate model.

Table V.  Favourable prognostic factors for patients with localized disease at diagnosis (154 OS and ES patients with complete data).

	Univariate			Multivariate
	HR^1	95% CI^2	p	HR	95% CI	p
Extremity tumour	0.47	0.32–0.69	<0.001	0.43	0.27–0.68	<0.001
Decreasing tumour size^3	0.94	0.90–0.99	0.01	0.94	0.91–0.98	0.001
In prospective trial	0.40	0.26–0.61	<0.001	0.56	0.32–0.97	0.04
Diagnosis ≥ 1995^4	0.54	0.30–0.97	0.04	0.54	0.28–1.04	0.07
Age ≤ 40	0.41	0.27–0.61	<0.001	0.61	0.35–1.06	0.08
High chemotherapy intensity	0.47	0.29–0.77	0.03	0.62	0.35–1.09	0.10
Female sex	0.76	0.51–1.16	0.21	0.66	0.41–1.09	0.10
Diagnosis ≥ 1990	0.68	0.45–1.02	0.06	0.91	0.45–1.85	0.79
Symptom duration ≤ 6 months	0.93	0.56–1.51	0.75	–	–	–
Ewing tumour	0.96	0.61–1.51	0.86	–	–	–

¹Hazards ratio.

²Confidence interval.

³Analysed as a continuous variable where the HR indicates the decrease in risk for each cm of decrease in size.

⁴Altering the diagnostic period cut-off to 1995 re-introduced age ≤ 40 as a significant factor (p = 0.03), but did not otherwise affect the order or significance level of the factors in the multivariate model.