title: Post operative infection and increased survival in osteosarcoma patients: are they associated?
abstract: BACKGROUND
  Despite neo-adjuvant chemotherapy osteosarcomas having significant mortality, recent studies have shown survival advantages following infections for some tumour types. This study investigates the effect of post-operative infection in patients treated for osteosarcoma using endoprosthetic replacement and neo-adjuvant chemotherapy.
  
  
  METHODS
  A consecutive series of 547 patients underwent surgery between 1981 and 2001 for osteosarcoma. Patients were excluded from the study if over 60 years old at diagnosis (n = 14) as they would not routinely receive chemotherapy. Studies showed that 70% of deep infections occur within one year from reconstruction. Therefore landmark analysis was performed; all patients infected after 12 months of reconstruction were excluded (15 patients, 2.7%) and those who died within 12 months from diagnosis due to metastases were excluded (105 patients, 19.2%), leaving 412 patients. Any survival advantage of early infection was analysed by Kaplan-Meier survival analysis from this landmark point.
  
  
  RESULTS
  Overall population survival was 65% at 10 years after landmarking. There were 41 patients (10%) who developed an infection within one year of implantation. These patients had significantly better survival (p = 0.017). The 10-year survival for patients with osteosarcoma with infection was 84.5% compared to 62.3% in the non-infected group after landmarking. There was no significant difference in the percentage post-chemotherapy specimen necrosis between the two groups (p = 0.36). Infection was an independent prognostic factor on cox regression analysis.
  
  
  CONCLUSIONS
  There was evidence for increased survival after deep post-operative infection in osteosarcoma patients, in keeping with other research. The authors feel this warrants further investigation.
authors.affiliation: Royal Orthopaedic Hospital Oncology Service, Bristol Road South, Northfield, Birmingham, B31 2AP, United Kingdom. lee.jeys@btclick.com
authors.forename: L M
authors.initials: LM
authors.lastname: Jeys
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
authors.forename: S R
authors.initials: SR
authors.lastname: Carter
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
authors.forename: A
authors.initials: A
authors.lastname: Abudu
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005121:Extremities / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D019919:Prosthesis Implantation; D016459:Prosthesis-Related Infections / Q000401:mortality*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality*; D013290:Streptococcal Infections / Q000401:mortality*; D013530:Surgical Wound Infection / Q000401:mortality*