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Effect of increases in tumor volume after neoadjuvant chemotherapy on the outcome of stage II osteosarcoma regardless of histological response

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

We assessed volume changes after neoadjuvant chemotherapy and evaluated relations between tumor size changes and clinical characteristics. In addition, we sought to determine whether tumor size change influences patient outcome.

Methods

The records of 127 patients with stage II osteosarcoma who showed more than a 15% volume change after chemotherapy were retrospectively reviewed. Patients were divided into two groups depending on whether tumors increased or decreased in size. Fisher’s exact test was performed to analyze correlations between tumor size changes and clinicopathological variables. Five-year metastasis-free survival and overall survival were evaluated using univariate and multivariate analyses.

Results

A total of 71 patients (55.9%) showed a decrease in tumor volume, and 56 patients (44.1%) showed an increase. An increase in tumor volume after neoadjuvant chemotherapy was found to be positively correlated with a poor histological response and subsequent metastasis. Univariate analysis identified the following parameters as poor prognostic factors: age ≤15 years (P = 0.03), American Joint Committee on Cancer (AJCC) stage IIB (P = 0.02), a subtype other than osteoblastic (P < 0.01), a poor histological response (P < 0.001), and increased tumor volume after preoperative chemotherapy (P < 0.0001). Multivariate analysis revealed that AJCC stage IIB (P = 0.006) and an increase in tumor volume after preoperative chemotherapy (P < 0.001) both independently shortened metastasis-free survival. However, a poor histological response lost its prognostic significance (P = 0.34).

Conclusions

Increased tumor volume after neoadjuvant chemotherapy independently shortened metastasis-free and overall survival in AJCC stage II osteosarcoma patients. Tumor volume changes may serve as a basis for risk-adapted therapy when used in combination with other prognostic factors.

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Authors and Affiliations

  1. Department of Pathology, Korea Cancer Center Hospital, Seoul, Korea

    Min Suk Kim & Jae-Soo Koh

  2. Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4 Gongneung-dong, Nowon-gu, Seoul, 139-706, Korea

    Soo-Yong Lee, Wan Hyeong Cho, Won Seok Song & Dae-Geun Jeon

  3. Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea

    Jun Ah Lee

  4. Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea

    Ji Young Yoo

  5. Department of Orthopedic Surgery, Chonnam National University Medical School, Gwangju, Korea

    Sung Taek Jung

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  1. Min Suk Kim
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Kim, M.S., Lee, SY., Cho, W.H. et al. Effect of increases in tumor volume after neoadjuvant chemotherapy on the outcome of stage II osteosarcoma regardless of histological response. J Orthop Sci 14, 292–297 (2009). https://doi.org/10.1007/s00776-009-1334-y

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  • DOI: https://doi.org/10.1007/s00776-009-1334-y

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