Which factors affect the prognosis of osteosarcoma?

Updated: Dec 04, 2018
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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Answer

In osteosarcoma, the foremost initial question for staging is whether the tumor has metastasized. Other tumor features, though not technically used in staging, may impact the prognosis. These include the following:

  • LDH and ALP measurements
  • Site of primary tumor (mostly related to ease of complete resection)
  • Histologic response to chemotherapy
  • Cause of the disease (patients with osteosarcomas arising from Paget disease have a particularly poor prognosis)

Patients with isolated jaw lesions tend to do better and have a lower incidence of metastases.

Different primary tumor sites are associated with differing prognoses, as follows:

  • Distal extremity – Best
  • Distal femur – Intermediate
  • Axial skeleton – Worst

In a retrospective study by Kim et al, the records of 331 patients with stage II osteosarcoma who underwent surgery and chemotherapy were reviewed. [29] The authors found that the initial tumor size appears to be associated with histologic response and is an important prognostic factor in osteosarcoma.

Patients with tumors that have a good histologic response (the definition of which is still under debate) to preoperative chemotherapy appear to have a better prognosis, though this still is under investigation.


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