Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database.
Journal Article (Journal Article)
BACKGROUND: Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the type of surgical resection chosen for osteosarcoma patients in the twenty-first century. METHODS: Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Differences between patients undergoing amputation and patients undergoing limb salvage are described. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. RESULTS: From a total of 2442 patients, 1855 underwent limb salvage and 587 underwent amputation. Patients undergoing amputation were more likely to be older, male, uninsured, and live in zip codes associated with lower income. Patients undergoing amputation were also more likely to have larger tumors, more comorbid conditions, and metastatic disease at presentation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p < 0.001). Although this may well reflect underlying biases impacting choice of treatment, this survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.71; p < 0.01). CONCLUSION: Among patients in the NCDB, amputation for osteosarcoma is associated with advanced age, advanced stage, larger tumors, greater comorbidities, and lower income. Limb salvage is associated with a significant survival benefit, even when controlling for significant confounding variables and differences between cohorts.
Full Text
Duke Authors
- Blazer III, Dan German
- Brigman, Brian Eugene
- Eward, William Curtis
- Somarelli, Jason Andrew
- Visgauss, Julia Dawn
Cited Authors
- Evans, DR; Lazarides, AL; Visgauss, JD; Somarelli, JA; Blazer, DG; Brigman, BE; Eward, WC
Published Date
- October 14, 2020
Published In
Volume / Issue
- 20 / 1
Start / End Page
- 995 -
PubMed ID
- 33054722
Pubmed Central ID
- PMC7557006
Electronic International Standard Serial Number (EISSN)
- 1471-2407
Digital Object Identifier (DOI)
- 10.1186/s12885-020-07502-z
Language
- eng
Conference Location
- England