Osteosarcoma natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Common complications of osteosarcoma include pathologic fracture and metastasis. The 5-year survival rate of osteosarcoma after adequate therapy is approximately 60-80%. The presence of metastasis is associated with a particularly poor prognosis. Histologically, the embryonal type rhabdomyosarcoma and anatomically, the orbital and genitourinary tract rhabdomyosarcomas have the most favorable prognosis.
Complications
- The most frequent complications of osteosarcoma are pathologic fracture and the development of metastatic disease.
- Most common sites of metastasis are the bone, lung, and regional lymph nodes.
Prognosis
The 5-year survival rate of osteosarcoma after adequate therapy is approximately 60-80%. Pretreatment factors that influence outcome of the osteosarcoma include the following:
Primary tumor site
Pelvis
- Survival rates for patients with pelvic primary tumors are 20% to 47%.
- Complete surgical resection is associated with positive outcome for osteosarcoma of the pelvis.
Craniofacial/head and neck
- In patients with craniofacial osteosarcoma, those with mandibular tumors have a significantly better prognosis than do patients with extragnathic tumors.
Extraskeletal
- With current combined-modality therapy, the outcome for patients with extraskeletal osteosarcoma appears to be similar to that for patients with primary tumors of bone.
Size of the primary tumor
- Larger tumors have a worse prognosis than smaller tumors.
- Serum lactate dehydrogenase (LDH), which also correlates with outcome, is a likely surrogate for tumor volume.
Metastatic disease
Patients with localized disease have a much better prognosis than do patients with overt metastatic disease. As many as 20% of patients will have radiographically detectable metastases at diagnosis, with the lung being the most common site. The prognosis for patients with metastatic disease appears to be determined largely by the site, the number of metastases, and the surgical resectability of the metastatic disease:
Site of metastases
- Prognosis appears more favorable for patients with fewer pulmonary nodules and for those with unilateral rather than bilateral pulmonary metastases.
Number of metastases
- Patients with skip metastases (at least two discontinuous lesions in the same bone) have been reported to have inferior prognoses.
- Skip metastasis in a bone other than the primary bone should be considered systemic metastasis.
- Patients with multifocal osteosarcoma (defined as multiple bone lesions without a clear primary tumor) have an extremely poor prognosis.