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Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database.

Publication ,  Journal Article
Evans, DR; Lazarides, AL; Visgauss, JD; Somarelli, JA; Blazer, DG; Brigman, BE; Eward, WC
Published in: BMC Cancer
October 14, 2020

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.

Duke Scholars

Published In

BMC Cancer

DOI

EISSN

1471-2407

Publication Date

October 14, 2020

Volume

20

Issue

1

Start / End Page

995

Location

England

Related Subject Headings

  • Young Adult
  • United States
  • Survival Analysis
  • Retrospective Studies
  • Osteosarcoma
  • Oncology & Carcinogenesis
  • Male
  • Limb Salvage
  • Humans
  • Female
 

Citation

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Evans, D. R., Lazarides, A. L., Visgauss, J. D., Somarelli, J. A., Blazer, D. G., Brigman, B. E., & Eward, W. C. (2020). Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database. BMC Cancer, 20(1), 995. https://doi.org/10.1186/s12885-020-07502-z
Evans, Daniel R., Alexander L. Lazarides, Julia D. Visgauss, Jason A. Somarelli, Dan G. Blazer, Brian E. Brigman, and William C. Eward. “Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database.BMC Cancer 20, no. 1 (October 14, 2020): 995. https://doi.org/10.1186/s12885-020-07502-z.
Evans DR, Lazarides AL, Visgauss JD, Somarelli JA, Blazer DG, Brigman BE, et al. Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database. BMC Cancer. 2020 Oct 14;20(1):995.
Evans, Daniel R., et al. “Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database.BMC Cancer, vol. 20, no. 1, Oct. 2020, p. 995. Pubmed, doi:10.1186/s12885-020-07502-z.
Evans DR, Lazarides AL, Visgauss JD, Somarelli JA, Blazer DG, Brigman BE, Eward WC. Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database. BMC Cancer. 2020 Oct 14;20(1):995.
Journal cover image

Published In

BMC Cancer

DOI

EISSN

1471-2407

Publication Date

October 14, 2020

Volume

20

Issue

1

Start / End Page

995

Location

England

Related Subject Headings

  • Young Adult
  • United States
  • Survival Analysis
  • Retrospective Studies
  • Osteosarcoma
  • Oncology & Carcinogenesis
  • Male
  • Limb Salvage
  • Humans
  • Female