Survival profiles and associated factors for overall and cancer specific survival in patients with chondroblast and fibroblastic osteosarcoma

Abstract

We aimed to compare overall survival (OS) and cancer-specific survival (CSS) between patients with chondroblastic osteosarcoma and fibroblastic osteosarcoma, and to identify prognostic risk factors for these subtypes. Clinical and demographic data from 723 patients with either chondroblastic osteosarcoma or fibroblastic osteosarcoma were extracted from the SEER database. Cox proportional hazards models were used to assess the association of these two types of osteosarcoma with OS, while Fine-Gray competing risk models evaluated CSS, with adjustments for covariates in both unweighted and inverse probability treatment-weighted (IPTW) samples. Subsequent univariate and multivariate analyses identified prognostic factors specific to each subtype. We did not observe any statistically significant differences in terms of the association of the two pathological types of osteosarcomas with OS and CSS using either unweighted or weighted samples. For chondroblastic osteosarcoma, OS was significantly associated with age ≥ 30 years, non-Hispanic Black race, first cancer, primary site, T2-4 stage, M1 stage, and having chemotherapy and surgery were significantly associated with the OS. CSS was associated with age ≥ 30 years, T2-4 stage, M1 stage, and having surgery were associated factors for CSS. In patients with fibroblastic osteosarcoma, OS was significantly associated with primary site, M1 stage, and having radiation and surgery. While CSS was associated with primary site, T2-T4 and TX stage, N1 and M1 stage, and having radiation and surgery. The present study demonstrated the survival profiles of patients with chondroblastic and fibroblastic osteosarcoma. Patients with fibroblastic osteosarcoma do not have better OS or CSS compared with those with chondroblastic osteosarcoma. Multiple risk factors for a poor prognosis were identified, and they can be used to refine the therapeutic approach.

Keywords: Chondroblast osteosarcoma; Fibroblastic osteosarcoma; Risk factors; Survival analysis; Survival outcomes.

Fig. 1

Multivariable Cox regression analysis of prognostic factors in chondroblastic vs. fibroblastic osteosarcoma (unweighted cohort). Forest plots display hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival (OS) with red horizontal lines and cancer-specific survival (CSS) with blue horizontal lines. Reference lines at HR = 1 (null effect) are shown as a vertical black line.

Fig. 2

Multivariable Cox regression analysis after inverse probability treatment weighting (IPTW). Forest plots show adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) in the IPTW-balanced cohort. Red horizontal lines are for overall survival (OS), and blue horizontal lines are for cancer-specific survival (CSS). Reference lines at HR = 1 (null effect) are shown as a vertical black line.