Survival Analysis of Patients with Osteosarcoma around the Knee Treated by Limb-salvage Surgery
1.Department of Spine Surgery,Central Hospital of Longgang District
2.Department of Orthopaedic Surgery,Musculoskeletal Tumor Center,the First Affiliated Hospital of Sun Yat-Sen University
Abstract:Objective To investigate the clinical efficacy,limb function,survival and complication of patients treated limb-salvage surgery for osteosarcoma around the knee. Methods We retrospectively reviewed the clinical data for 120 patients with osteosarcoma around the knee who treated with limb-salvage surgery between1998 to 2008.The sample included 75 males and 45 females.The mean age of the patients was 18.9 years,ranged from 5 to 48 years.Osteosarcoma was diagnosed in the distal femur in 78 patients and in the proximal tibia in 42 patients.85 patients received standard chemotherapy,while 35 patients received non-standard chemotherapy.Statistical analyses were conducted to process and record patient data and analyze the surgery's efficacy,prognosis and survival rates.Results All patients were followed for 6 to 144 months,with a mean length of 56.8 months.Twelve of the 120 patients (10%) required secondary amputation.The 5-year overall survival rate for the 120 patients was 61.8%.The 5-years overall survival rates were 71.6% for patients treated with standard chemotherapy and 40% for those treated with non-standard chemotherapy.There was a significant difference in survival rates between the treatments (P<0.01).The average MSTS score was 25.47 points.There was no significant difference in postoperative knee flexion between patients with tumor in the distal femur and tumor in the proximal tibia.However,there was a higher incidence of extensor lag in patients with tumor in the proximal tibia than those with tumor in the distal femur,and the difference was significant (P=0.03).Conclusion Currently,limb-salvage surgery combined with neoadjuvant chemotherapy is the option for treating osteosarcoma around the knee.It can preserve knee function and appearance well,but has a relatively high incidence of complications.
[1]Abed R,Grimer R.Surgical modalities in the treatment of bone sarcoma in children[J].Cancer Treat Rev,2010,36(4):342-347.
[2]Robert RS,Ottaviani G,Huh W W,et al.Psychosocial and functional outcomes in long-term survivors of osteosarcoma:a comparison of limb-salvage surgery and amputation[J].Pediatr Blood Cancer,2010,54(7):990-999.
[3]Mangat KS,Jeys LM,Carter SR.Latest developments in limb-salvage surgery in osteosarcoma[J].Expert Rev Anticancer Ther,2011,11(2):205-215.
[4]Jeys LM,Kulkarni A,Grimer RJ,et al.Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis[J].J Bone Joint Surg(Am),2008,90(6):1265-1271.
[5]Hogendoorn PC,Athanasou N,Bielack S,et al.Bone sarcomas:ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up[J].Ann Oncol,2010,21 (Suppl 5):204-213.
[6]Federman N,Bernthal N,Eilber FC,et al.The multidisciplinary management of osteosarcoma[J].Curr Treat Options Oncol,2009,10(1-2):82-93.
[7]Aksnes LH,Bauer HC,Jebsen NL,et al.Limb-sparing surgery preserves more function than amputation:a Scandinavian sarcoma group study of 118 patients[J].J Bone Joint Surg(Br),2008,90(6):786-794.
[8]Aksnes LH,Hall KS,Jebsen N,et al.Young survivors of malignant bone tumours in the extremities:a comparative study of quality of life,fatigue and mental distress[J].Support Care Cancer,2007,15(9):1087-1096.
[9]Rougraff BT,Simon MA,Kneisl JS,et al.Limb salvage compared with amputation for osteosarcoma of the distal end of the femur.A long-term oncological,functional,and quality-of-life study[J].J Bone Joint Surg(Am),1994,76(5):649-656.
[10]Renard AJ,Veth RP,Schreuder HW,et al.Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone[J].J Surg Oncol,2000,73(4):198-205.
[11]Hegyi M,Semsei AF,Jakab Z,et al.Good prognosis of localized osteosarcoma in young patients treated with limb-salvage surgery and chemotherapy[J].Pediatr Blood Cancer,2011,57(3):415-422.
[12]Ayerza MA,Farfalli GL,Aponte-Tinao L,et al.Does increased rate of limb-sparing surgery affect survival in osteosarcoma?[J].Clin Orthop Relat Res,2010,468(11):2854-2859.
[13]Ferrari S,Smeland S,Mercuri M,et al.Neoadjuvant chemotherapy with high-dose Ifosfamide,high-dose methotrexate,cisplatin,and doxorubicin for patients with localized osteosarcoma of the extremity:a joint study by the Italian and Scandinavian Sarcoma Groups[J].J Clin Oncol,2005,23(34):8845-8852.
[14]Sluga M,Windhager R,Lang S,et al.Local and systemic control after ablative and limb sparing surgery in patients with osteosarcoma[J].Clin Orthop Relat Res,1999(358):120-127.
[15]Honegger HP,Cserhati MD,Exner GU,et al.Zurich experience with preoperative,high dose methotrexate-containing chemotherapy in patients with extremity osteosarcomas (OSA)[J].Ann Oncol,1991,2(7):489-494.
[16]Jeys LM,Grimer RJ,Carter SR,et al.Periprosthetic infection in patients treated for an orthopaedic oncological condition[J].J Bone Joint Surg (Am),2005,87(4):842-849.
[17]Jeys L,Grimer R.The long-term risks of infection and amputation with limb salvage surgery using endoprostheses[J].Recent Results Cancer Res,2009,179(1):75-84.
[18]Carty CP,Bennett MB,Dickinson IC,et al.Electromyographic assessment of gait function following limb salvage procedures for bone sarcoma[J].J Electromyogr Kinesiol,2010,20(3):502-507.
[19]Carty CP,Bennett MB,Dickinson IC,et al.Assessment of kinematic and kinetic patterns following limb salvage procedures for bone sarcoma[J].Gait Posture,2009,30(4):547-551.
[20]Bramer JA,van Linge JH,Grimer RJ,et al.Prognostic factors in localized extremity osteosarcoma:a systematic review[J].Eur J Surg Oncol,2009,35(10):1030-1036.
[21]Tsauo JY,Li WC,Yang RS.Functional outcomes after endoprosthetic knee reconstruction following resection of osteosarcoma near the knee[J].Disabil Rehabil,2006,28(1):61-66.
[22]Ek EW,Rozen WM,Ek ET,et al.Surgical options for reconstruction of the extensor mechanism of the knee after limb-sparing sarcoma surgery:an evidence-based review[J].Arch Orthop Trauma Surg,2011,131(4):487-495.