title: Role of surgical margin on local recurrence in high risk extremity osteosarcoma: a case-controlled study.
abstract: BACKGROUND
  The relationship between surgical margin and local recurrence (LR) in osteosarcoma patients with poor responses to chemotherapy is unclear. Moreover, the incidences of LR according to three different resection planes (bone, soft tissue, and perineurovascular) are not commonly known.
  
  
  METHODS
  We evaluated the incidence of LR in three areas. To assess whether there is a role of surgical margin on LR in patients resistant to preoperative chemotherapy, we designed a case (35 patients with LR) and control (70 patients without LR) study. Controls were matched for age, location, initial tumor volume, and tumor volume change during preoperative chemotherapy.
  
  
  RESULTS
  LR occurred at the soft tissues in 18 cases (51.4%), at the perineurovascular tissues in 11 cases (31.4%), and at the bones in six cases (17.2%). The proportion of inadequate perineurovascular margin was higher in the case group than in the control group (p = 0.01). Within case-control group (105 patients), a correlation between each margin status and LR at corresponding area was found in the bone (p < 0.001) and perineurovascular area (p = 0.001).
  
  
  CONCLUSIONS
  LR is most common in soft tissues. In patients showing similar unfavorable responses to chemotherapy, the losses of perineurovascular fat plane on preoperative magnetic resonance imaging may be a valuable finding in predicting LR.
authors.affiliation: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea. dgjeon@kcch.re.kr
authors.forename: Dae-Geun
authors.initials: DG
authors.lastname: Jeon
authors.forename: Won Seok
authors.initials: WS
authors.lastname: Song
authors.forename: Chang-Bae
authors.initials: CB
authors.lastname: Kong
authors.forename: Wan Hyeong
authors.initials: WH
authors.lastname: Cho
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Cho
authors.forename: Jeong Dong
authors.initials: JD
authors.lastname: Lee
authors.forename: Soo-Yong
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual / Q000473:pathology; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011859:Radiography
keywords: Local recurrence; Osteosarcoma; Surgical margin