Which factors affect the prognosis of osteosarcoma?

Updated: Jul 01, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Omohodion (Odion) Binitie, MD  more...
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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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