Limb Salvage is Associated with Improved Survivorship in Upper and Lower Extremity Osteosarcoma

SA Traven MD, DL Brinton, ZJ Walton MD, LR Leddy MD

BACKGROUND

METHODS

• With recent advances in limb salvage techniques, the trend in treatment of osteosarcoma (OS) has progressed towards limb salvage over the last 4 decades.

• Studies comparing limb salvage with amputation continue to show comparable outcomes with local recurrence, survival and functional outcomes, but these studies are limited by small sample sizes.

OBJECTIVES

This is the largest survivorship analysis of patients with osteosarcoma undergoing limb salvage versus amputation.

• 4,056 patients with upper or lower extremity osteosarcoma were identified in the National Cancer Institute’s SEER Database.

• Patients were divided into two groups based on surgery treatment arm – those undergoing limb salvage versus amputation.

• Multivariable logistic regression was used to control for demographic data and potential confounders including tumor site, histology, and AJCC stage.

DISCUSSION

RESULTS

Worse survivorship was associated with: 1. Older age

2. Black race

3. Upper extremity location

4. NOS histology

5. AJCC class III, IV

• Amputation is associated with any-cause mortality and disease-specific mortality.

• Older patients, blacks, upper extremity disease, and NOS histology are worse prognostic factors.

• Tumors that necessitate an amputation will have worse outcomes.

• This is likely due to inherent selection bias with variables that are not being recorded:

1. Neurovascular involvement 2. Progression on chemotherapy 3. Non-functional extremity after resection

• These variables, which play a role in surgeon

selection of amputation over limb salvage, likely also self-select for more aggressive tumors.

Limb Salvage

Amputation

Figure 1. Overall survivorship by treatment arm

Figure 2. Disease-specific survivorship by treatment arm

RESULTS (Cont.)