Prognosis
Before the advent of chemotherapy the prognosis of osteosarcoma was poor, with 5-year disease-free survival rates ranging between 15% and 20% after surgical treatment. The use of chemotherapy in treating osteosarcoma has improved survival rates, particularly in patients with localised disease where survival rates now range from 75% to 80%.[36][37] The likelihood of local recurrence is 5% to 7%, and is related to surgical resection margins and responsiveness to chemotherapy.[26] Tumour recurrence has been reported to occur up to 20 years after successful treatment.
The most important adverse prognostic factors are detectable primary metastases and poor histological response to preoperative chemotherapy.[25] Other adverse prognostic factors include proximal extremity or axial tumour site, large tumour volume, and elevated serum alkaline phosphatase or lactate dehydrogenase.
Metastatic and recurrent disease
Patients with a primary lesion and an isolated pulmonary nodule at presentation have a 5-year event-free survival <40%; patients with multiple pulmonary nodules or detectable metastasis at other sites have a 5-year event-free survival <20%.[38]
Prognosis of recurrent osteosarcoma is poor, with 5-year post-relapse survival in <20%.[25] In cases where a second surgical remission is achieved, >33% of patients survive over 5 years.
Even patients with multiple recurrences may be cured as long as recurrences are resectable, and repeated thoracotomies are often warranted.
Use of this content is subject to our disclaimer