Prognosis of extremity osteosarcoma in patients aged 40-60 years: A cohort/case controlled study at a single institute

Background: The outcome of older osteosarcoma patients with multi-disciplinary management has not been clearly defined. Methods: We conducted a cohort (n = 375) and a case-control (n = 78) study on 26 older age patients (40-60 years) with localized osteosarcoma of extremity. In the case control study, controls were matched for location and initial tumor volume. Results: Compared to 349 younger patients, older age patients showed an osteolytic pattern on plain radiographs (P = 0.05), fibroblastic subtype (P <0.01), and poor histologic response (P = 0.03). Multivariate analysis revealed that a large absolute tumor volume (P <0.01), a tumor location in the proximal humerus (P = 0.02), and a poor histologic response to preoperative chemotherapy (P < 0.01) independently predicted poorer metastasis-free survival. However, an older age showed marginal significance (P = 0.09). A case control study showed a higher proportion of the fibroblastic subtype and poor histologic response in the case group. Five-year metastasis-free survival rates for the 26 cases and 52 controls were 40.1 +/- 10.1% and 61.5 +/- 6.8%, respectively (P = 0.02). Conclusions: Older age osteosarcoma patients showed an unfavorable histologic response to chemotherapy and lower survival than younger patients. Nevertheless, a further larger-scale study is required to confirm our observations. (C) 2010 Elsevier Ltd. All rights reserved.