Mohd Sofian, Azlan
(2015)
Evaluation of prognostic factors in
patients with osteosarcoma: the HUSM experience.
Masters thesis, Universiti Sains Malaysia.
Abstract
Introduction:
Osteosarcoma is a highly malignant primary bone tumour thus the
evaluation of prognostic factors influencing the survival rates is extremely
essential for defining the approach to the management of these patients.
Despite the recent advancement in chemotherapy and improved prognosis,
30 - 40% of patients still succumb to the disease; therefore reliable prognostic
factors would be essential to plan a more aggressive treatment in patients at a
higher risk of failure of treatment.
Among multiple variables evaluated in literatures, it is known that
pulmonary metastases and chemo-necrosis are the best prognostic
components on the survival. At present, there is no consensus on the
prognostic significance of simple and cheap biochemical markers of pretreatment
serum alkaline phosphate (ALP) and lactate dehydrogenase (LDH).
This study analyzed the prognostic factors of particularly ALP and LDH and
other general variable for prognosis and overall oncological outcome.
Method:
Clinical data of at least 5 years related to prognostic factors of 163
patients with osteosarcoma who were under follow-up under Hospital
Universiti Sains Malaysia were retrospectively reviewed. This was a
retrospective cohort study of all patients treated between January 2005 and
December 2010. A total of 163 patients with the mean age of 18.9 years
(range 6 – 59 years old) were evaluated. There were 109 males and 54
females. Majority of the patients were of Malay ethnic background (82.2%),
compared to the Chinese (11.66%), followed by Indian ethnicity (4.29%).
55.2% of our patients presented with pulmonary metastases. In terms of type
of surgery, 66.1% of our patients underwent limb salvage surgery and 33.9%
underwent amputation.
Results:
The overall survival was 40.5%. The mean pre-treatment serum LDH
level was 493.19 IU/L, and 52.8% of our patients had high values. The mean
level of pre-treatment ALP was 273.93 IU/L, and 53% of our patients had high
values. The 5-year overall survival rate of patients in the normal pre-treatment
serum LDH group is 66.2%, whereas in the high pre-treatment serum LDH
group is 17.4%.
The 5-year overall survival rate of patients in the normal pre-treatment
serum ALP group is 55.8 %, whereas in the high pre-treatment serum ALP
group is 26.7%. In the multivariate statistical analysis, only the pre-treatment
serum LDH and presence of metastasis maintained its prognostic significance
as both the pre-treatment serum ALP and the type of surgery loses its
independent predictive value.
In regards to the other variables, 66.9% of our patients were male, with
the overall survival of 39.4%. Our female patients had a similar overall
survival of 42.6%. Pulmonary metastases presented in 90 patients (55.2%).
The overall survival of these patients was 27.8% compared to 56.2% in those
without metastatic disease. For patients who underwent limb-sparing surgery,
their overall survival was 56.8%, whereas in the amputation group the overall
survival was 17.6%.
Conclusion:
The overall survival of our osteosarcoma patients was influenced by
the presence of pulmonary metastases and type of surgery. Pre-treatment
serum LDH and ALP were of significant influence on the final survival.
However age, gender, race, primary site of tumour, histological sub-type,
were not of significant influence on the survival of our patients.
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