title: Tumor volume increase during preoperative chemotherapy as a novel predictor of local recurrence in extremity osteosarcoma.
abstract: BACKGROUND
  Known risk factors (surgical margin, tumor necrosis) of local recurrence (LR) in osteosarcoma are determined by results available after surgery. However, relations between preoperative characteristics and LR have not been clearly defined.
  
  
  METHODS
  We compared the clinicopathologic characteristics of 36 osteosarcoma patients with LR and 394 patients without LR after surgery. In addition, prognostic variables were evaluated to establish factors could influence LR.
  
  
  RESULTS
  Compared to the non-LR group, the LR group showed an increase in tumor volume ratio (TVR) during preoperative chemotherapy (P < 0.01), inadequate surgical margin (P < 0.01), and poor histologic response (P < 0.01). Univariate analysis of data from 430 patients revealed that an increased TVR (P < 0.01), inadequate surgical margin (P < 0.01), poor histologic response (P < 0.01), and nonosteoblastic pathologic subtype (P = 0.04) were negatively related to LR-free survival. In multivariate analysis, an elevated TVR (P < 0.01, relative risk = 10.26) and inadequate surgical margin (P < 0.01, relative risk = 5.91) emerged as the key prognostic factors for LR.
  
  
  CONCLUSIONS
  A TVR increase during preoperative chemotherapy could be used to predict patients at high risk of LR. This finding might be useful when considering surgical options to decrease the risk of LR.
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Song
authors.forename: Dae-Geun
authors.initials: DG
authors.lastname: Jeon
authors.forename: Chang-Bae
authors.initials: CB
authors.lastname: Kong
authors.forename: Wan Hyeong
authors.initials: WH
authors.lastname: Cho
authors.forename: Jae-Soo
authors.initials: JS
authors.lastname: Koh
authors.forename: Jun Ah
authors.initials: JA
authors.lastname: Lee
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Yoo
authors.forename: Sung Taek
authors.initials: ST
authors.lastname: Jung
authors.forename: Duk Seop
authors.initials: DS
authors.lastname: Shin
authors.forename: Soo-Yong
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D002648:Child; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005121:Extremities / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology; D012516:Osteosarcoma / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D011300:Preoperative Care; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate