title: Prognosis of extremity osteosarcoma in patients aged 40-60 years: a cohort/case controlled study at a single institute.
abstract: BACKGROUND
  The outcome of older osteosarcoma patients with multi-disciplinary management has not been clearly defined.
  
  
  METHODS
  We conducted a cohort (n=375) and a case-control (n=78) study on 26 older age patients (40-60 years) with localized osteosarcoma of extremity. In the case-control study, controls were matched for location and initial tumor volume.
  
  
  RESULTS
  Compared to 349 younger patients, older age patients showed an osteolytic pattern on plain radiographs (P=0.05), fibroblastic subtype (P<0.01), and poor histologic response (P=0.03). Multivariate analysis revealed that a large absolute tumor volume (P<0.01), a tumor location in the proximal humerus (P=0.02), and a poor histologic response to preoperative chemotherapy (P<0.01) independently predicted poorer metastasis-free survival. However, an older age showed marginal significance (P=0.09). A case-control study showed a higher proportion of the fibroblastic subtype and poor histologic response in the case group. Five-year metastasis-free survival rates for the 26 cases and 52 controls were 40.1+/-10.1% and 61.5+/-6.8%, respectively (P=0.02).
  
  
  CONCLUSIONS
  Older age osteosarcoma patients showed an unfavorable histologic response to chemotherapy and lower survival than younger patients. Nevertheless, a further larger-scale study is required to confirm our observations.
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Republic of Korea.
authors.forename: W S
authors.initials: WS
authors.lastname: Song
authors.forename: C-B
authors.initials: CB
authors.lastname: Kong
authors.forename: D-G
authors.initials: DG
authors.lastname: Jeon
authors.forename: W H
authors.initials: WH
authors.lastname: Cho
authors.forename: M S
authors.initials: MS
authors.lastname: Kim
authors.forename: J A
authors.initials: JA
authors.lastname: Lee
authors.forename: J Y
authors.initials: JY
authors.lastname: Yoo
authors.forename: J D
authors.initials: JD
authors.lastname: Kim
authors.forename: S-Y
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000367:Age Factors; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005121:Extremities; D005260:Female; D006801:Humans; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies