Osteogenic sarcoma of the mandible and maxilla: a Canadian review (1980-2000).
OBJECTIVE
To determine factors that influence survival in patients with osteogenic sarcoma of the jaws.


METHODS
Multicentre retrospective clinical pathologic study of 35 patients with osteogenic sarcoma of the jaws by the Canadian Society of Otolaryngology-Head and Neck Surgery Oncology Study Group.


METHODS
Clinical charts and pathology results were reviewed on 35 patients treated between 1980 and 2000 for osteogenic sarcoma of the maxilla or mandible. Records were acquired from several major Canadian cancer registries. The following variables were examined for the effect on survival: age, gender, tumour site, grade and subtype, margins, and method of treatment.


RESULTS
The average age of patients was 40 years (range 14-76 years). The sex distribution was similar, with 18 males and 17 females. The primary site was the mandible in 20 patients and the maxilla in 15 patients. The overall survival was 79 +/- 7% at 2 years and 57 +/- 9% at 5 years. Local recurrence (41%) was more common than distant metastases (17%). Positive margins were the factor most strongly associated with poor prognosis on multivariate analysis (hazard ratio = 3.5, p < .04). Disease-free survival dropped to zero by 3 years for those with positive margins (n = 7). For those who were resected with clear margins (n = 25), 5-year disease-free survival remained greater than 50% and the overall survival rate was almost 80%. Tumour site, grade, and subtype did not correlate with prognosis. There was a trend toward better prognosis in those who received chemotherapy in addition to surgery.


CONCLUSIONS
Osteogenic sarcoma of the jaws is an aggressive disease with a high mortality rate despite a relatively low risk of distant metastases. Negative margins are paramount for optimizing survival rate. Chemotherapy, although contentious, should be considered given the data from long bone studies and the trend toward better survival in several studies, including ours.
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000401:mortality*; D008441:Maxillary Neoplasms / Q000401:mortality*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000401:mortality* / Q000556:secondary; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate