Prognostic importance of pathologic fracture and surgical implications in osteosarcoma: a retrospective clinical study

اهميت شكستگي پاتولوژيك و نوع درمان جراحي در پيش آگهي استئوساركوما يك مطالعه باليني گذشته نگر

Background & Aims: Osteosarcoma is one of the most prevalent malignant bone tumors . This study is designed to assess the prognostic effect of pathologic fracture and treatment options on survival of patients with osteosarcoma. Materials & Methods: In this study, prognosis of 106 patients with limb osteosarcoma, which were treated at three hospitals in Tehran from April to August 2012 was evaluated. Patients were divided in two groups according to the presence of pathologic fracture at the time of diagnosis. Survival, local recurrence and distant metastasis were compared between groups. For patients with pathologic fracture, survival rate was compared according to surgical options (amputation or limb salvage). Chi-square and Independent sample T-test were used to compare means of the groups. Recurrence free and metastasis free survivals and final survival of the patients were calculated using the Kaplan-Meier method. To determine the predictive factors of survival, Cox-Regression analysis and estimating hazard ratio (HR) with 95% confidence interval were used. Results: Among 106 patients, 57 cases had not and 49 others had a pathologic fracture at the time of diagnosis. There were no statistically difference between two groups in Survival (P-value=0.36), local recurrence (P-value=0.91) and distant metastasis (Pvalue= 0.73). There was no statistically difference in survival according to surgical options in patients with pathologic fracture (Pvalue= 0.85). Conclusion: pathologic fracture in limb osteosarcoma is not a poor prognostic factor. In patients with pathologic fracture limb salvage procedures can be performed without adverse effect on survival rate.