title: Prognostic factors in the survival of patients diagnosed with primary non-metastatic osteosarcoma with a poor response to neoadjuvant chemotherapy.
abstract: BACKGROUND
  Identification of variables that determine the prognosis for osteosarcoma may enable stratification of patients into subgroups with better or worse risk of local recurrence, metastases and death due to the disease. Discovery of such prognostic factors would permit selection of a subgroup of at-risk patients, with the aim of improving the therapeutic effectiveness.
  
  
  OBJECTIVE
  To identify prognostic factors related to local recurrence-free survival, metastasis-free survival and overall survival among patients with highly malignant primary osteosarcoma that was non-metastatic on diagnosis and had poor response to neoadjuvant chemotherapy.
  
  
  METHODS
  Out of 45 patients admitted to a referral center in Brazil between 2000 and 2004, 24 were selected for this study.
  
  
  RESULTS
  The adverse factors that influenced the risk of local recurrence and the overall survival in univariate analysis were histological subtype other than osteoblastic (p = 0.017) and tumor size greater than 15 cm (p = 0.048). In relation to metastasis-free survival, the non-osteoblastic subtype had a worse prognosis (p = 0.007). The association of histological subtype maintained its significance in multivariate analysis for all studied survival categories.
  
  
  CONCLUSIONS
  Tumor size greater than 15 cm is an adverse factor for local recurrence-free survival and overall survival but did not influence metastasis-free survival. The osteosarcoma histological type is a significant independent predictor for local recurrence-free survival, metastasis-free survival and overall survival.
authors.affiliation: Faculty of Medicine, University of Campina Grande - Campina Grande/PB, Brazil. zosimo_jr@yahoo.com.br
authors.forename: Rosalvo Zósimo
authors.initials: RZ
authors.lastname: Bispo Júnior
authors.forename: Olavo Pires de
authors.initials: OP
authors.lastname: Camargo
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D012516:Osteosarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D011379:Prognosis; D012307:Risk Factors; D017211:Treatment Failure; D047368:Tumor Burden; D055815:Young Adult