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Volume 2015, Article ID 516843, 14 pages
Research Article

Prognostic Factors and Treatment Results of High-Grade Osteosarcoma in Norway: A Scope Beyond the “Classical” Patient

1Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway
2The Norwegian Cancer Registry, 0304 Oslo, Norway
3Department of Oncology, Haukeland University Hospital, 5020 Bergen, Norway
4Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424 Oslo, Norway
5Department of Orthopedics, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway
6Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway

Received 26 September 2014; Accepted 12 January 2015

Academic Editor: Eugenie S. Kleinerman

Copyright © 2015 Kjetil Berner et al. 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.


Purpose. A retrospective study of prognostic factors and treatment outcome of osteosarcoma (OS) during modern chemotherapy era with focus on patients with primary metastatic disease, nonextremity localisation, or age >40 years (nonclassical OS). Methods. A nationwide cohort, comprising 424 high-grade Norwegian bone OS patients, was based on registry sources supplemented with clinical records from hospitals involved in sarcoma management between 1975 and 2009. Results. Only 48% were younger patients with tumour in the extremities and without metastasis at diagnosis (classical OS). A considerable discrepancy in survival between classical and nonclassical OS was observed: 61% versus 26% 10-year sarcoma specific survival. Twice as many of the former received both adequate surgery and chemotherapy compared to the latter. This could only partly explain the differences in survival due to inherent chemoresistance in primary metastatic disease and a higher rate of local relapse among patients with axial tumours. Metastasis at diagnosis, increased lactate dehydrogenase, age > 40 years, and tumour size above median value were all adverse prognostic factors for overall survival. Conclusion. We confirm a dramatic difference in outcome between classical and nonclassical high-grade OS patients, but treatment variables could only partly explain the dismal outcome of the latter.