Inadequate medical intervention as prognostic factor in osteosarcoma

S Specterman, J M Lastiri, M S Varela, H Gioseffi, M E Lopez Lincuez, G Z Beguelin, M Makiya, E Dibar, D L Muscolo, M G Pallotta

Research output: Contribution to journalArticlepeer-review

Abstract

9041 Background: Osteosarcoma is an aggressive disease. Survival has been improved to greater than 75% in most of the last trials. This is due to progress in surgical technique, polychemotherapy and fundamentally because of the multidisciplinary work. Inadequate medical intervention (IMI) (mistakes in the biopsy planning, pathological interpretation or surgery) could impair the osteosarcoma evolution. We compare two groups of patients managed with the same standard of care in our multidisciplinary group; one had a previous IMI and the other did not (control group).

METHODS: Since 11/1989 until 9/2002, 15 patients with diagnosis of osteosarcoma that had initiated treatment in other institutions and had IMI were evaluated. Nine men, median age 21,1 years (SD: 9,36), two with central localization. Overall survival (OS), disease free survival (DFS), limb sparing and relapses of these patients were evaluated.

RESULTS: erroneous diagnoses were: aneurysmal bone cist (N=4), giant cell tumor (N=2), osteochondroma (N=2), osteoblastoma (N=2), fibrous dysplasia (N=1), osteomyelitis (N=1). Histological revision made by an experienced pathologist showed high-grade osteosarcoma in 11 patients and low grade in the rest. Erroneous initial diagnosis leaded to insufficient surgeries (intralesional) in 14 patients in other institutions. Limb sparing rate was lower versus our control population (p= 0.03). In the IMI group the local and systemic relapse rates were worse (40% versus 15%, p=0.000; and 60 versus 28.3%, p=0.04 respectively). Five year SV of patients with IMI was 24.9% versus 65.3% of control group (p= 0.02). DFS was lower in the IMI group: 18.5 vs. 72.2 months (p= 0.01).

CONCLUSIONS: IMI modified evolution of patients with osteosarcoma dramatically. IMI reduces OS, DFS and decreases conservational possibilities. Specialized multidisciplinary teams should treat every patient with osteosarcoma suspicion. No significant financial relationships to disclose.

Original languageEnglish
Pages (from-to)9041
JournalJournal of clinical oncology : official journal of the American Society of Clinical Oncology
Volume22
Issue number14_suppl
Publication statusPublished - 15 Jul 2004

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