Bacci et al identified prognostic factors in patients treated for an osteosarcoma of an extremity. These can help identify patients who may require more aggressive management. The authors are from Instituto Ortopedico Rizzoli in Bologna, Italy.
Patient selection: osteosarcoma in an extremity with no evidence of metastasis at diagnosis, age < 40 years, with preoperative chemotherapy followed by resection
Prognostic factors associated with recurrence based on multivariate analysis:
(1) age of the patient
(2) serum alkaline phosphatase concentration
(3) tumor volume
(4) number of drugs in chemotherapy regimen
(5) surgical margin
(6) histologic response to preoperative chemotherapy
|
Parameter |
Finding |
Points |
|
age of the patient |
<= 14 years of age |
1 |
|
|
> 14 years of age |
0 |
|
serum alkaline phosphatase |
normal |
0 |
|
|
elevated |
1 |
|
tumor volume |
< 200 mL (diameter < 7.25 cm) |
0 |
|
|
>= 200 mL (diameter >= 7.25 cm) |
1 |
|
drug regimen |
2 drugs |
1 |
|
|
3 or 4 drugs |
0 |
|
surgical margin |
adequate (radical or wide) |
0 |
|
|
inadequate (marginal, intralesional, or contaminated, even if necrotic tumor) |
1 |
|
histologic response |
good (>= 90% necrosis) |
0 |
|
|
poor (< 90% necrosis) |
1 |
where:
• The reference range for alkaline phosphatase is affected by age and gender.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• The higher the score the greater the risk of tumor recurrence.
Specialty: Hematology Oncology, Surgery, general, Surgery, orthopedic
ICD-10: ,
