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

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.

Fig. 1

a Overall incidence of Osteosarcoma plotted by year of diagnosis and normalized to the US 2000 census. b Age adjusted histogram depicting the Incidence rate for Osteosarcoma normalized to the 2000 US Standard Population. Disease-specific survival estimates for c all patients, compared to survival stratified by d age, e grade, f stage, g location. [Kaplan–Meier method, corresponding data Table 2]

Fig. 2

Disease-specific survival for patients with osteosarcoma stratified by a surgical intervention, b radiation and c year of diagnosis (Kaplan–Meier method, corresponding data Table 2), d Disease-specific survival plots for patients with osteosarcoma stratified by histology

Fig. 3

Disease-specific survival for patients with high-grade osteosarcoma stratified by ‘year of diagnosis’ P values: 1986–1995 vs. 1996–2005 = 0.029, 1976–1985 vs. 1996–2005 = 0.027, 1973–1975 = 0123, 1976–1985 vs. 1986–1995 = 0.643, 1973–1975 vs. 1986–1995 = 0.343 and 1973–1975 vs. 1976–1985 = 0.514

Fig. 4

Disease-specific survival for patients with low-grade osteosarcoma stratified by ‘year of diagnosis’ P values: 1986–1995 vs. 1996–2005 = 0.017, 1976–1985 vs. 1996–2005 = 0.344, 1973–1975 vs. 1976–1985 = 0.529, 1976–1985 vs. 1986–1995 = 0.013, 1973–1975 vs. 1986–1995 = 0.366 and 1973–1975 vs. 1996–2005 = 0.613