Mialou et al identified prognostic factors for pediatric patients with metastatic osteosarcoma. These can help identify patients who may benefit from more aggressive management. The authors are from multiple Childrens' hospitals in France (in Lyn, Villejuif, Marseille, Paris and Lille).
Patient selection: Patients < 20 years of age with metastatic osteosarcoma
Prognostic factors:
(1) serum alkaline phosphatase
(2) number of metastatic sites (organs with 1 or more metastatic lesions)
Parameter |
Finding |
Points |
serum alkaline phosphatase |
<= 500 IU/L |
0 |
|
> 500 IU/L |
1 |
number of metastatic sites |
1 |
0 |
|
>= 2 |
1 |
where:
• 500 IU/L was the median serum concentration at the time of diagnosis.
• The use of the term "metastatic sites" is a little ambiguous in the text. According to the abstract it refers to organ sites involved, rather than the total of metastatic lesions.
number of prognostic factors =
= SUM(points for both prognostic factors)
Interpretation:
• minimum number of prognostic factors: 0
• maximum number of prognostic factors: 2
Number of Prognostic Factors |
5 Year Event Free Survival |
5 Year Overall Survival |
0 |
24% |
39% |
1 or 2 |
3% |
5% |
where:
• Survival after 5 years tends to be flat for the next 10 years.
Other prognostic factors mentioned:
(1) complete vs incomplete resection of primary tumor and all metastases (Table 5, page 1106).
(2) complete vs incomplete remission after therapy
Limitations:
• I could not find any description of the alkaline phosphatase method or its normal reference range. This makes the given cutoff useless for transporting the algorithm to a different site. The only way to do this would be to determine the median alkaline phosphatase value at presentation using local methods.
Specialty: Hematology Oncology, Surgery, general, Surgery, orthopedic
ICD-10: ,