Survival and prognostic factors in pediatric osteosarcoma: A 5-year single-center experience in Central Java, Indonesia
Abstract
Background The advent of chemotherapy with multimodal treatment has improved the survival rate of osteosarcoma. However, the survival rate of patients with osteosarcoma in low- and middle-income countries (LMICs) remains lower than in high-income countries (HICs).
Objective To assess prognostic factors associated with survival rate of pediatric patients with osteosarcoma in Moewardi Hospital, Surakarta.
Methods This retrospective study was performed in pediatric osteosarcoma patients at Moewardi Hospital, Surakarta from 2018 to 2022. We described patients’ clinical presentations and assessed prognostic factors. Survival rate was calculated using Kaplan–Meier survival analysis. Prognostic factors were analyzed using univariate and multivariate Cox regression methods.
Results Of the 82 patients included in the study, 40 (48.8%) were male and 42 (51.2%) were female. Most subjects (75.6%) were diagnosed with osteosarcoma at the age of >10 years, 45 patients (54.9%) had primary tumors in the femur, and 16 patients (19.5%) had limb salvage surgery. The mean event-free survival duration was 13.6 (95%CI 9.7 to 17.5) months. The mean duration of overall survival was 22.7 (95%CI 17.3 to 28.1) months, with a 44.1% survival probability. Type of surgery was a significant prognostic factor (P=0.018), with limb salvage having better survival probability (93.3%) than amputation (19.8%).
Conclusion The overall survival rate of osteosarcoma patients at our center is still lower than in other regional centers. Limb salvage surgery was a significant prognostic factor for survival, while gender, location of primary tumor, histological subtype, and metastasis at the time of diagnosis were not.
References
2. Wang W, Yang J, Wang Y, Wang D, Han G, Jia J, et al. Survival and prognostic factors in Chinese patients with osteosarcoma: 13-year experience in 365 patients treated at a single institution. Pathol Res Pract. 2017;213:119–25. DOI: https://doi.org/10.1016/j.prp.2016.11.009
3. Yasin NF, Abdul Rashid ML, Ajit Singh V. Survival analysis of osteosarcoma patients: a 15-year experience. J Orthop Surg. 2020;28. DOI: https://doi.org/10.1177/2309499019896662
4. Monsereenusorn C, Alcasabas AP, Loh AHP, Soh SY, Leung KWP, Dhamne C, et al. Predictors and treatment outcomes of pediatric osteosarcoma in diverse socioeconomic backgrounds in Southeast Asia: a retrospective multicenter study. Asian Pacific J Cancer Prev. 2022;23:631–40. DOI: https://doi.org/10.31557/APJCP.2022.23.2.631
5. Pruksakorn D, Phanphaisarn A, Pongnikorn D, Daoprasert K, Teeyakasem P, Chaiyawat P, et al. Age-standardized incidence rates and survival of osteosarcoma in Northern Thailand. Asian Pacific J of Cancer Prev. 2016;17:3455–8. DOI: https://doi.org/10.14456/apjcp.2016.116/APJCP.2016.17.7.3455
6. Mailankody S, Kumar VS, Khan SA, Banavali SD, Bajpai J. Resource-appropriate selection of osteosarcoma treatment protocols in low- and middle-income countries. Pediatr Blood Cancer. 2022;69:e29540. DOI: https://doi.org/10.1002/pbc.29540.
7. Nie Z, Peng H. Osteosarcoma in patients below 25 years of age: an observational study of incidence, metastasis, treatment and outcomes. Oncol Lett. 2018;16:6502–14. DOI: https://doi.org/10.3892/ol.2018.9453.
8. Evenhuis RE, Acem I, Rueten-Budde AJ, Karis DSA, Fiocco M, Dorleijn DMJ, et al. Survival analysis of 3 different age groups and prognostic factors among 402 patients with skeletal high-grade osteosarcoma. Real world data from a single tertiary sarcoma center. Cancers (Basel). 2021;13:486. DOI: https://doi.org/10.3390/cancers13030486
9. Sjakti HA, Putri IA, Windiastuti E. Survival rate of pediatric osteosarcoma in Indonesia: a single center study. Paediatr Indones. 2022;62:27–31. DOI: https://doi.org/10.14238/pi62.1.2022.27-31
10. Lin YH, Jewell BE, Gingold J, Lu L, Zhao R, Wang LL, et al. Osteosarcoma: molecular pathogenesis and iPSC modeling. Trends in Mol Med. 2017;23:737–55. DOI: https://doi.org/10.1016/j.molmed.2017.06.004
11. Gianferante DM, Mirabello L, Savage SA. Germline and somatic genetics of osteosarcoma - connecting aetiology, biology and therapy. Nature Reviews Endocrinology. 2017;13:480-91. DOI: https://doi.org/10.1038/nrendo.2017.16
12. Aisyi M, Syarif AH, Anggraeni NA, Perdana AB, Rezky H, Kosasih A, et al. Survival analysis in pediatric osteosarcoma. Indones J Cancer. 2019;13:21. DOI: https://doi.org/10.33371/ijoc.v13i2.622
13. Wiromrat P, Jetsrisuparb A, Komvilaisak P, Sirichativapee W, Kamsa-ard S, Wiangnon S. Incidence and survival rates among pediatric osteogenic sarcoma cases in Khon Kaen, Thailand, 1985-2010. Asian Pacific J of Cancer Prev. 2012;13:4281–4. DOI: https://doi.org/10.7314/APJCP.2012.13.9.4281
14. Choeyprasert W, Natesirinilkul R, Charoenkwan P, Sittipreechacharn S. Carboplatin and doxorubicin in treatment of pediatric osteosarcoma: a 9-year single institute experience in the northern region of Thailand. Asian Pacific J of Cancer Prev. 2013;14:1101–6. DOI: https://doi.org/10.7314/APJCP.2013.14.2.1101
15. Poudel RR, Tiwari V, Kumar VS, Bakhshi S, Gamanagatti S, Khan SA, et al. Factors associated with local recurrence in operated osteosarcomas: a retrospective evaluation of 95 cases from a tertiary care center in a resource challenged environment. J Surg Oncol. 2017;115:631–6. DOI: https://doi.org/10.1002/jso.24602
16. Vasquez L, Silva J, Chavez S, Zapata A, Diaz R, Tarrillo F, et al. Prognostic impact of diagnostic and treatment delays in children with osteosarcoma. Pediatr Blood Cancer. 2020 Apr 1;67(4). DOI:https://doi.org/10.1002/pbc.28180
17. Mailankody S, Kumar VS, Khan SA, Banavali SD, Bajpai J. Resource-appropriate selection of osteosarcoma treatment protocols in low- and middle-income countries. Pediatr Blood Cancer. 2022;69:e29540. DOI: 10.1002/pbc.29540
18. Kundu ZS, Gogna P, Gupta V, Kamboj P, Singla R, Sangwan SS. Proximal humeral reconstruction using nail cement spacer in primary and metastatic tumours of proximal humerus. Strategies Trauma Limb Reconstr. 2013;8:149–54. DOI: https://doi.org/ 10.1007/s11751-013-0172-9
19. Ganguly S, Kinsey S, Bakhshi S. Childhood cancer in India. Cancer Epidemiol. 2021;71: 101679. DOI: https://doi.org/10.1016/j.canep.2020.101679
20. Gaston CL, Taleon K, Bersales K, Dimayuga C, Estanislao J, Fajardo P, et al. The Effect of a Patient Navigator on Treatment Abandonment and Follow-up for High Grade Osteosarcoma Patients in the Philippine General Hospital. Asian Pacific Journal of Cancer Prevention. 2021 Sep 1;22(9):2873–7. DOI: https://doi.org/ 10.31557/APJCP.2021.22.9.2873
21. Bajpai J, Puri A, Shah K, Susan D, Jambhekar N, Rekhi B, et al. Chemotherapy compliance in patients with osteosarcoma. Pediatr Blood Cancer. 2013;60:41–4. DOI: https://doi.org/10.1002/pbc.24155
22. Faisham WI, Mat Saad AZ, Alsaigh LN, Nor Azman MZ, Kamarul Imran M, Biswal BM, et al. Prognostic factors and survival rate of osteosarcoma: a single-institution study. Asia Pac J Clin Oncol. 2017;13:e104–10. DOI: https://doi.org/10.1111/ajco.12346
23. Vasquez L, Tarrillo F, Oscanoa M, Maza I, Geronimo J, Paredes G, et al. Analysis of prognostic factors in high-grade osteosarcoma of the extremities in children: a 15-year single-institution experience. Front Oncol. 2016;6:22. DOI: https://doi.org/10.3389/fonc.2016.00022
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Accepted 2024-02-20
Published 2024-02-20
