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Effect of increases in tumor volume after neoadjuvant chemotherapy on the outcome of stage II osteosarcoma regardless of histological response
Journal of Orthopaedic Science, 06/10/09

Kim MS et al. - In a study to assessed volume changes after neoadjuvant chemotherapy and evaluate relations between tumor size changes and clinical characteristics as well as to determine whether tumor size change influences pt outcome, it appears that increased tumor volume after neoadjuvant chemotherapy independently shortened metastasis-free and overall survival (OS) in AJCC stage II osteosarcoma pts. Tumor volume changes may serve as a basis for risk-adapted therapy when used in combination with other prognostic factors.

Methods

Records of 127 pts with stage II osteosarcoma who showed more than a 15% volume change after chemotherapy were retrospectively reviewed.
Pts were divided into 2 groups depending on whether tumors increased or decreased in size.
Fisher’s exact test was performed to analyze correlations between tumor size changes and clinicopathological variables.
5-yr metastasis-free survival and OS were evaluated using univariate and multivariate analyses.

Results

71 pts (55.9%) showed a decrease in tumor volume, and 56 pts (44.1%) showed an increase.
An increase in tumor volume after neoadjuvant chemotherapy was positively correlated with a poor histological response and subsequent metastasis.
Univariate analysis identified the following parameters as poor prognostic factors: age ≤15 yrs, American Joint Committee on Cancer (AJCC) stage IIB, a subtype other than osteoblastic, poor histological response, and increased tumor volume after preoperative chemotherapy.
Multivariate analysis revealed that AJCC stage IIB and an increase in tumor volume after preoperative chemotherapy both independently shortened metastasis-free survival.
Poor histological response lost its prognostic significance.

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