The importance of standardized treatment in high-grade osteosarcoma: 30 years of experience from a hospital-based database

Figures & data

Table I. Patients characteristic and treatment modalities of high-grade osteosarcoma in western Denmark in the time period 1979–2008 (n = 169).

	Time periode
Factors	1979–1988 No. of patients (%)	1989–1998 No. of patients (%)	1998–2008 No. of patients (%)
No. of patients	54	55	60
Median age (range)	18 (6–72)	22 (4–81)	20 (5–81)
Sex
Male	33 (61)	36 (65)	34 (57)
Female	21 (39)	19 (35)	26 (43)
Stage at diagnosis
Localized	49 (91)	44 (80)	43 (72)
Lung metastasis	3 (6)	6 (11)	10 (17)
Distant metastasis	2 (3)	5 (9)	7 (11)
Anatomic location
Axial	9 (17)	16 (29)	15 (25)
Extremity	45 (83)	39 (71)	45 (75)
Tumor size
Mean (range)	9 (3–20)	8 (1–21)	10 (3–21)
Soft tissue extension
Yes	43 (80)	45 (82)	53 (88)
No	11 (20)	10 (18)	7 (12)

Table II. Treatment modalities of high-grade osteosarcoma in western Denmark in the time period 1979–2008 (n = 169).

	Time period
Factors	1979–1988 No. of patients (%)	1989–1998 No. of patients (%)	1998–2008 No. of patients (%)
Curative intended treatment
No. of patients	48	47	48
Surgery
Amputation	38 (79)	24 (51)	16 (33)
Wide margin
Yes	36	23	15
No	2	1	1
Resection	10 (21)	23 (49)	32 (67)
Wide margin
Yes	7	20	29
No	3	3	3
Chemotherapy
Yes	14 (29)	42 (89)	44 (92)
Dox*+ cis**	0	32	28
MAP***	1	1	14
Dox+ cis+ mitocycin	11	2	0
Other	2	7	2
No	34 (71)	5 (11)	4 (8)
Performance status/age	1	1	3
Radiation therapy	2
Amputation alone	31
Other		4	1
Necrosis
< 90%		15 (32)	23 (48)
≥ 90%		13 (28)	14 (29)
Missing/not analyzed	48 (100)	19 (40)	11 (23)
Radiation
Yes	4 (8)	1 (2)	2 (4)
No	44 (92)	46 (98)	46 (96)
Relapse
Primary not cured	1 (2)	4 (9)	4 (8)
Yes	32 (67)	25 (53)	22 (46)
No	15 (31)	18 (38)	22 (46)
Palliative treatment
No. of patients	6	8	12
Surgery
Amputation	0	0	1
Resection	0	0	2
Chemotherapy
Yes	4	5	6
No	2	3	6
Radiation therapy
Yes	4	6	4
No	2	2	8

*Dox, doxorubicin; **cis, cisplatin; ***MAP, doxorubicin, cisplatin and metrotrexat ± ifosfamid/etoposide/interferon.

Figure 1. Overall survival for all high-grade osteosarcoma patients (n = 169) in the time period 1979–2008.

Figure 2. Predicted overall survival for patient treated with curative intent by treatment (A) and year of diagnosis (B), using the univariate Cox proportional hazard regression model (n = 135). Standard treatment was regarded as wide excision combined with optimal chemotherapy. Inadequate treatment included all curative treatment other than standard treatment.

Table III. Uni- and multivariate analysis of possible prognostic factors for overall survival (OS) in all patients with high-grade localized osteosarcoma treated with curative intent (n = 135).

			Univariate		Multivariate
	n (%)	5-year OS (95%CI)	HR	95% CI	HR	95% CI
Age
< 40	108 (81)	52 (42;61)	1		1
≥ 40	26 (19)	38 (20;56)	1.6	(0.97;2.74)	1.29	(0.73;2.28)
Anatomic location
Axial	23 (17)	46 (37;55)	1
Extremity	111 (83)	65 (42;81)	0.94	(0.51;1.62)
Soft tissue extension
No	28 (21)	68 (47;82)	1		1
Yes	106 (80)	45 (35;54)	2.1	(1.10;3.93)	2.25	(1.06;4.54)
Size of primary tumor*
1 cm			1.05	(0.99;1.11)	1.03	(0.98;1.09)
Treatment^#
Standard
Yes	81 (60)	55 (44;65)	1		1
No	53 (40)	40 (27;53)	1.75	(1.12;2.73)	1.88	(1.15;3.08)
Necrosis***
< 90	37 (64)	40 (25;56)	1		1
≥ 90	21 (36)	70 (45;86)	0.32	(0.13;0.79)	0.28	(0.11;0.72)

*11 missing value; ***not included in the multivariate analysis, HR for necrosis has been adjusted for other prognostic factors; ^#standard treatment is wide margin surgery and standard chemotherapy.