Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database
Abstract Background Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the type of surgical...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Cancer |
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| Online Access: | http://link.springer.com/article/10.1186/s12885-020-07502-z |
| _version_ | 1818340956077817856 |
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| author | Daniel R. Evans Alexander L. Lazarides Julia D. Visgauss Jason A. Somarelli Dan G. Blazer Brian E. Brigman William C. Eward |
| author_facet | Daniel R. Evans Alexander L. Lazarides Julia D. Visgauss Jason A. Somarelli Dan G. Blazer Brian E. Brigman William C. Eward |
| author_sort | Daniel R. Evans |
| collection | DOAJ |
| description | Abstract Background Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the type of surgical resection chosen for osteosarcoma patients in the twenty-first century. Methods Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Differences between patients undergoing amputation and patients undergoing limb salvage are described. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. Results From a total of 2442 patients, 1855 underwent limb salvage and 587 underwent amputation. Patients undergoing amputation were more likely to be older, male, uninsured, and live in zip codes associated with lower income. Patients undergoing amputation were also more likely to have larger tumors, more comorbid conditions, and metastatic disease at presentation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p < 0.001). Although this may well reflect underlying biases impacting choice of treatment, this survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.71; p < 0.01). Conclusion Among patients in the NCDB, amputation for osteosarcoma is associated with advanced age, advanced stage, larger tumors, greater comorbidities, and lower income. Limb salvage is associated with a significant survival benefit, even when controlling for significant confounding variables and differences between cohorts. |
| first_indexed | 2024-12-13T15:51:08Z |
| format | Article |
| id | doaj.art-b92ad38f040c4386b8f03dce3d449636 |
| institution | Directory Open Access Journal |
| issn | 1471-2407 |
| language | English |
| last_indexed | 2024-12-13T15:51:08Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cancer |
| spelling | doaj.art-b92ad38f040c4386b8f03dce3d4496362022-12-21T23:39:29ZengBMCBMC Cancer1471-24072020-10-0120111110.1186/s12885-020-07502-zLimb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer DatabaseDaniel R. Evans0Alexander L. Lazarides1Julia D. Visgauss2Jason A. Somarelli3Dan G. Blazer4Brian E. Brigman5William C. Eward6Duke University School of MedicineDepartment of Orthopaedic Surgery, Duke University HospitalDepartment of Orthopaedic Surgery, Duke University HospitalDuke Cancer Institute, Duke University HospitalDuke Cancer Institute, Duke University HospitalDepartment of Orthopaedic Surgery, Duke University HospitalDepartment of Orthopaedic Surgery, Duke University HospitalAbstract Background Historically, amputation was the primary surgical treatment for osteosarcoma of the extremities; however, with advancements in surgical techniques and chemotherapies limb salvage has replaced amputation as the dominant treatment paradigm. This study assessed the type of surgical resection chosen for osteosarcoma patients in the twenty-first century. Methods Utilizing the largest registry of primary osteosarcoma, the National Cancer Database (NCDB), we retrospectively analyzed patients with high grade osteosarcoma of the extremities from 2004 through 2015. Differences between patients undergoing amputation and patients undergoing limb salvage are described. Unadjusted five-year overall survival between patients who received limb salvage and amputation was assessed utilizing Kaplan Meier curves. A multivariate Cox proportional hazard model and propensity matched analysis was used to determine the variables independently correlated with survival. Results From a total of 2442 patients, 1855 underwent limb salvage and 587 underwent amputation. Patients undergoing amputation were more likely to be older, male, uninsured, and live in zip codes associated with lower income. Patients undergoing amputation were also more likely to have larger tumors, more comorbid conditions, and metastatic disease at presentation. After controlling for confounders, limb salvage was associated with a significant survival benefit over amputation (HR: 0.70; p < 0.001). Although this may well reflect underlying biases impacting choice of treatment, this survival benefit remained significant after propensity matched analysis of all significantly different independent variables (HR: 0.71; p < 0.01). Conclusion Among patients in the NCDB, amputation for osteosarcoma is associated with advanced age, advanced stage, larger tumors, greater comorbidities, and lower income. Limb salvage is associated with a significant survival benefit, even when controlling for significant confounding variables and differences between cohorts.http://link.springer.com/article/10.1186/s12885-020-07502-zLimb salvage surgeryAmputationOsteosarcomaOsteosarcoma of the extremitiesOverall survival |
| spellingShingle | Daniel R. Evans Alexander L. Lazarides Julia D. Visgauss Jason A. Somarelli Dan G. Blazer Brian E. Brigman William C. Eward Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database BMC Cancer Limb salvage surgery Amputation Osteosarcoma Osteosarcoma of the extremities Overall survival |
| title | Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database |
| title_full | Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database |
| title_fullStr | Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database |
| title_full_unstemmed | Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database |
| title_short | Limb salvage versus amputation in patients with osteosarcoma of the extremities: an update in the modern era using the National Cancer Database |
| title_sort | limb salvage versus amputation in patients with osteosarcoma of the extremities an update in the modern era using the national cancer database |
| topic | Limb salvage surgery Amputation Osteosarcoma Osteosarcoma of the extremities Overall survival |
| url | http://link.springer.com/article/10.1186/s12885-020-07502-z |
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