title: Tumor size and prognosis in aggressively treated osteosarcoma.
abstract: OBJECTIVE
  The aim of this retrospective analysis was to investigate the prognostic significance and optimal measures of tumor size in osteosarcoma treated with intensive neoadjuvant chemotherapy.
  
  
  METHODS
  Initial anterior-posterior (AP) and lateral x-ray films of 128 patients treated within the trials Cooperative Osteosarcoma Study (COSS)-80, -82, and -86, were evaluated for the following three tumor diameters: length, width, and depth. Metastasis-free survival (MFS) analyses were performed in univariate and multivariate models with one, two, and three dimensions of the tumor as absolute or relative measures (tumor length, referred to bone length, plane and volume to body-surface area).
  
  
  RESULTS
  Univariate analyses of MFS showed a high prognostic significance of all absolute measures. Relative measures, at best, showed a comparable predictive value. Cox regression analysis indicated the high prognostic significance of absolute tumor volume (ATV; P < .0001) and histologic response (P < .0001). None of 19 patients with an ATV < or = 70 cm3 and only four of 53 with an ATV < or = 150 cm3 relapsed, while in patients with an ATV more than 150 cm3, the relapse rate remained 40% to 60%, irrespective of further increase in volume.
  
  
  CONCLUSIONS
  Initial tumor size is an important and easily obtainable prognostic factor in osteosarcoma and may serve as a basis for risk-adapted therapy. It is best represented by the absolute three-dimensional measure ATV. There is a cut-off point regarding the incidence of metastases at a tumor volume of approximately 150 cm3 as calculated from two-plane x-ray films.
authors.affiliation: Department of Pediatric Oncology, University of Hamburg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Bieling
authors.forename: N
authors.initials: N
authors.lastname: Rehan
authors.forename: P
authors.initials: P
authors.lastname: Winkler
authors.forename: K
authors.initials: K
authors.lastname: Helmke
authors.forename: R
authors.initials: R
authors.lastname: Maas
authors.forename: N
authors.initials: N
authors.lastname: Fuchs
authors.forename: S
authors.initials: S
authors.lastname: Bielack
authors.forename: U
authors.initials: U
authors.lastname: Heise
authors.forename: H
authors.initials: H
authors.lastname: Jurgens
authors.forename: J
authors.initials: J
authors.lastname: Treuner
authors.forename: R
authors.initials: R
authors.lastname: Romanowski
authors.forename: U
authors.initials: U
authors.lastname: Exner
authors.forename: R
authors.initials: R
authors.lastname: Kotz
authors.forename: K
authors.initials: K
authors.lastname: Winkler
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002648:Child; D002986:Clinical Trials as Topic; D005121:Extremities; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies