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Volume 8, Issue 1, Pages 13-18

Comparison of the Outcome of Conventional Osteosarcoma at Two Specialist International Orthopaedic Oncology Centres

1Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
2The Istituto Ortopedico Rizzoli, Bologna, Italy

Copyright © 2004 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective: To determine the prognostic value of patient and treatment parameters in osteosarcoma, and whether these are equally important across international boundaries.

Design: Retrospective, cross-sectional study of 428 patients diagnosed with around-knee osteosarcoma, between 1990 and 1997 in Birmingham, UK, and Bologna, Italy. Disease-free survival (DFS) and overall survival (OS) assessed by Kaplan–Meier, Fisher's PLSD and Cox proportional hazard regression.

Results: Five-year DFS and OS were 56 and 73% at Centre 1, compared to 43 and 60% at Centre 2 (P=0.0022 and P = 0.025, respectively). The most important bad prognostic factors for DFS and OS respectively were raised alkaline phosphatase at diagnosis (P=0.002 and P=0.003), tumour necrosis < 90% following chemotherapy (P=0.001 and P = 0.004) and volume > 150 cm3 at diagnosis (P=0.04 and P=0.006). The most significant combination of bad prognostic factors was alkaline phosphatase and tumour necrosis. A total of 73% of patients at Centre 1 had greater than 90% necrosis of the tumour following neoadjuvant chemotherapy compared with 29% at Centre 2.

Conclusions: Tumour-based prognostic factors have similar significance across international boundaries. Chemotherapy effectiveness appears to be a major factor in explaining the survival difference between the two centres.