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Cited by 934Sarcoma Diagnosis and TreatmentBone Tumor Diagnosis and TreatmentsManagement of metastatic bone disease

Primary Metastatic Osteosarcoma: Presentation and Outcome of Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

Kager, Leo, Zoubek, Andreas, Pötschger, Ulrike, Kastner, Ulrike, Flege, Silke, Kempf-Bielack, Beate, Branscheid, Detlev, Kotz, Rainer +8 more·2003·Journal of Clinical Oncology
DOI 10.1200/jco.2003.08.132
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Abstract

Purpose: To determine demographic data and define prognostic factors for long-term outcome in patients presenting with high-grade osteosarcoma of bone with clinically detectable metastases at initial presentation. Patients and Methods: Of 1,765 patients with newly diagnosed, previously untreated high-grade osteosarcomas of bone registered in the neoadjuvant Cooperative Osteosarcoma Study Group studies before 1999, 202 patients (11.4%) had proven metastases at diagnosis and therefore were enrolled onto an analysis of demographic-, tumor-, and treatment-related variables, response, and survival. The intended therapeutic strategy included pre- and postoperative multiagent chemotherapy as well as aggressive surgery of all resectable lesions. Results: With a median follow-up of 1.9 years (5.5 years for survivors), 60 patients were alive, 37 of whom were in continuously complete surgical remission. Actuarial overall survival rates at 5 and 10 (same value for 15) years were 29% (SE = 3%) and 24% (SE = 4%), respectively. In univariate analysis, survival was significantly correlated with patient age, site of the primary tumor, number and location of metastases, number of involved organ systems, histologic response of the primary tumor to preoperative chemotherapy, and completeness and time point of surgical resection of all tumor sites. However, after multivariate Cox regression analysis, only multiple metastases at diagnosis (relative hazard rate [RHR] = 2.3) and macroscopically incomplete surgical resection (RHR = 2.4) remained significantly associated with inferior outcomes. Conclusion: The number of metastases at diagnosis and the completeness of surgical resection of all clinically detected tumor sites are of independent prognostic value in patients with proven primary metastatic osteosarcoma.

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Crossref · 10.1200/jco.2003.08.132

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  • The number of metastases and completeness of excision seem to affect outcomes.

    “Here, the number of metastases and completeness of excision seem to affect outcomes 6 .”

    From Osteosarcoma (2022) · cites this paper as [6]

  • Outcomes for patients with unresectable or widely metastatic osteosarcoma deemed incurable are very poor, with <30% surviving long term.

    “Patients with unresectable or widely metastatic osteosarcoma who are deemed incurable are generally managed with the same systemic therapy options, including MAP chemotherapy and local tumour control, and outcomes are very poor, with <30% of patients surviving long term 6 .”

    From Osteosarcoma (2022) · cites this paper as [6]

  • Patients with unresectable or widely metastatic osteosarcoma deemed incurable are generally managed with the same systemic therapy options, including MAP chemotherapy and local tumour control.

    “Patients with unresectable or widely metastatic osteosarcoma who are deemed incurable are generally managed with the same systemic therapy options, including MAP chemotherapy and local tumour control, and outcomes are very poor, with <30% of patients surviving long term 6 .”

    From Osteosarcoma (2022) · cites this paper as [6]

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Authors
Kager, L., Zoubek, A., Pötschger, U., Kastner, U., Flege, S., Kempf-Bielack, B., Branscheid, D., Kotz, R., Salzer-Kuntschik, M., Winkelmann, W., Jundt, G., Kabisch, H., Reichardt, P., Jürgens, H., Gadner, H., & Bielack, S. S.
Affiliations
  • University of Vienna (AT)
  • From the St Anna Children’s Hospital and Departments of Orthopaedics and Pathology, University Hospital of Vienna, Vienna, Austria; Centre for Pneumonology and Thoracic Surgery, Grosshansdorf; Department of Pediatrics, University Hospital of Hamburg, Hamburg; Charite, Campus Berlin-Buch, Robert Roessle Klinik, Berlin; Department of Orthopaedics, University Hospital of Muenster, and Department of Pediatric Hematology and Oncology, University Children’s Hospital Muenster, Germany; and Institute for...
ORCID
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2003-05-15
Volume
21
Issue
10
Pages
2011-2018
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.2003.08.132
OpenAlex
W2127748864
Cited by
934
References
38
Citations by year
2026: 42 · 2025: 50 · 2024: 66 · 2023: 77 · 2022: 71 · 2021: 55 · 2020: 68 · 2019: 37 · 2018: 34 · 2017: 49 · 2016: 55 · 2015: 59 · 2014: 50 · 2013: 34 · 2012: 29
FWCI
11.81
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Clinical Oncology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
  • Health Sciences › Medicine › Rheumatology › Bone Tumor Diagnosis and Treatments
  • Health Sciences › Medicine › Surgery › Management of metastatic bone disease
Keywords
high-grade osteosarcoma, neoadjuvant chemotherapy, prognostic factors, overall survival, number of metastases, incomplete resection, combination chemotherapy, surgical resection
MeSH terms
Adolescent, Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Bone Neoplasms, Child, Child, Preschool, Cisplatin, Clinical Trials as Topic, Combined Modality Therapy, Doxorubicin, Europe, Female, Humans, Ifosfamide, Male, Methotrexate, Middle Aged, Neoplasm Metastasis, Prognosis, Osteosarcoma, Proportional Hazards Models, Survival Analysis, Treatment Outcome, Disease-Free Survival, Neoadjuvant Therapy

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