Outcome for adolescent and young adult patients with osteosarcoma: a report from the Children's Oncology Group

Abstract

Background: There are conflicting data regarding age as a prognostic factor in osteosarcoma. The authors conducted a study evaluating the impact of age on prognosis in children and young adults with osteosarcoma enrolled on North American cooperative group trials.

Methods: Patients with high-grade osteosarcoma of any site enrolled on North American cooperative group trials CCG-7943, POG-9754, INT-0133, and AOST0121 were included in this study. Primary tumor site, age, sex, ethnicity, histologic response, and presence of metastatic disease at diagnosis were evaluated for their impact on overall survival (OS) and event-free survival (EFS).

Results: A total of 1054 patients were eligible and had complete data available for the study. Age was not significantly associated with any other presenting covariate analyzed except sex. Age 18 or older was associated with a statistically significant poorer EFS (P = .019) and OS (P = .043). The 10-year EFS and OS in patients <10, 10 to 17, and ≥18 years old were 55%, 55%, 37% and 68%, 60%, 41%, respectively. The poorer EFS in patients ≥18 years old was because of an increased rate of relapse. Presence of metastatic disease at diagnosis, poor histologic response, and pelvic tumor site were also associated with a poorer prognosis. In multivariate analysis, age continued to be associated with poorer EFS (P = .019) and OS (P = .049).

Conclusions: In osteosarcoma, age 18 to 30 years is associated with a statistically significant poorer outcome because of an increased rate of relapse. Poorer outcome in adolescent and young adult patients is not explained by tumor location, histologic response, or metastatic disease at presentation.

Figure 1

Event-free and overall survival of all patients aged 1 to 30 years in the study population (n = 1054) are shown.

Figure 2

Event-free and overall survival of all patients are shown by age at study enrollment, stratified by study and presence of metastatic disease at diagnosis.

Figure 3

Overall survival is shown by age of patients with localized osteosarcoma, stratified by study.

Figure 4

Event-free survival is shown by event type and age, stratified by study. SMN, second malignant neoplasm.

Figure 5

Postsurgery event-free survival (EFS) and postsurgery overall survival are shown by age and necrosis. (Poor necrosis: <95% necrosis; good necrosis: ≥95% necrosis.)