title: Results of the Brazilian Osteosarcoma Treatment Group Studies III and IV: prognostic factors and impact on survival.
abstract: OBJECTIVE
  To evaluate the impact of chemotherapy and surgery on the outcome of osteosarcoma (OS) of the extremities and to identify prognostic factors in Brazilian patients.
  
  
  METHODS
  A total of 225 patients with metastatic and nonmetastatic OS of the extremities were enrolled and assessed in two consecutive studies designed and implemented by the Brazilian Osteosarcoma Treatment Group.
  
  
  RESULTS
  The 5-year survival and event-free survival rates for the 209 assessable patients were 50.1% and 39%, respectively; for the 178 patients with nonmetastatic disease at diagnosis, the rates were 60.5% and 45.5%, respectively. The multivariate analysis showed that the following variables were associated with a shorter survival: metastases at diagnosis (P < .001), necrosis grades 1 and 2 (P = .046), and tumor size (P = .0071).
  
  
  CONCLUSIONS
  The overall 5- and 10-year survival rates were lower than the rates reported in North American and European trials. A pattern of advanced disease at diagnosis was often present, with a high proportion of patients having metastases (20.8%) and large tumor size (42.9%). However, these features were not necessarily associated with longer duration of prediagnostic symptoms. These findings were considered in the strategic planning of the current Brazilian cooperative study, with the aim of improving survival and quality of life of a large number of patients with OS.
authors.affiliation: Instituto de Oncologia Pediátrica, Grupo de Apoio ao Adolescente e à Criança com Câncer/Universidade Federal de São Paulo, São Paulo, Brazil. iopepm@dialdata.com.br
authors.forename: A Sérgio
authors.initials: AS
authors.lastname: Petrilli
authors.forename: Beatriz
authors.initials: B
authors.lastname: de Camargo
authors.forename: Vicente Odone
authors.initials: VO
authors.lastname: Filho
authors.forename: Paula
authors.initials: P
authors.lastname: Bruniera
authors.forename: Algemir L
authors.initials: AL
authors.lastname: Brunetto
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Jesus-Garcia
authors.forename: Olavo P
authors.initials: OP
authors.lastname: Camargo
authors.forename: Walter
authors.initials: W
authors.lastname: Pena
authors.forename: Pedro
authors.initials: P
authors.lastname: Péricles
authors.forename: Alexandre
authors.initials: A
authors.lastname: Davi
authors.forename: José D
authors.initials: JD
authors.lastname: Prospero
authors.forename: Maria Teresa S
authors.initials: MT
authors.lastname: Alves
authors.forename: Claudia R
authors.initials: CR
authors.lastname: Oliveira
authors.forename: Carla R D
authors.initials: CR
authors.lastname: Macedo
authors.forename: Wellington L
authors.initials: WL
authors.lastname: Mendes
authors.forename: Maria Teresa A
authors.initials: MT
authors.lastname: Almeida
authors.forename: Maria L
authors.initials: ML
authors.lastname: Borsato
authors.forename: Telma M
authors.initials: TM
authors.lastname: dos Santos
authors.forename: Jorge
authors.initials: J
authors.lastname: Ortega
authors.forename: Elio
authors.initials: E
authors.lastname: Consentino
mesh_terms: D000293:Adolescent; D000671:Amputation, Surgical; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D001938:Brazil; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D023821:Limb Salvage; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D015999:Multivariate Analysis; D019637:Orthopedic Procedures / Q000379:methods; D012516:Osteosarcoma / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D004317:Doxorubicin; D016190:Carboplatin; D002945:Cisplatin; D007069:Ifosfamide; D008727:Methotrexate