Primary tumor resection in patients with metastatic osteosarcoma

Sophia A. Traven, Ashley B. Anderson, Zeke J. Walton, Lee R. Leddy

Abstract

Background: Osteosarcoma with metastatic disease at the time of presentation necessitates a very different clinical discussion with patients than those who present with isolated disease. Therefore, the purpose of this study was to evaluate the role of local control surgery in patients with metastatic osteosarcoma as well as to further investigate confounding variables such as demographic, socioeconomic, and tumor characteristics on the overall and cancer-specific mortality rates.
Methods: The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program was queried for all patients with a diagnosis of metastatic osteosarcoma between the years 2004–2014. Patients who did not undergo any treatment (excisional surgery or chemotherapy) for their disease, were diagnosed at autopsy, or whose histologic subtypes were surface (parosteal and periosteal) or secondary osteosarcomas (Paget’s and radiation-induced) were excluded from further analyses. Multivariate models were used to isolate and evaluate the impact of excisional surgery of the primary tumor on the likelihood of survivorship.
Results: A total of 3,277 patients were identified, of which 42.5% underwent excisional surgery of the primary tumor. The 5-year survival rate for all patients with metastatic osteosarcoma was 24.4% whereas it was 34.5% in patients who underwent surgery and 5.8% in those who did not undergo surgery. Patients in the lowest quartile for income and education were more likely to be treated nonoperatively. Older age, axial location, and lower education level portended a much worse overall- and cancer-specific mortality. However, surgical excision of the primary tumor was most strongly associated with prolonged survivorship.
Conclusions: Patients with metastatic osteosarcoma whose primary tumor characteristics are amenable to surgery have a better prognosis than patients whose tumor characteristics preclude surgical resection.
Level of evidence: III prognostic.