title: Analysis of outcomes in extraskeletal osteosarcoma: a review of fifty-three cases.
abstract: BACKGROUND
  Extraskeletal osteosarcoma is a rare soft-tissue sarcoma about which little is known. The objectives of this study were to describe the clinical features and natural history of extraskeletal osteosarcoma and to investigate factors affecting outcomes.
  
  
  METHODS
  A retrospective review of a prospectively maintained database of patients diagnosed with soft-tissue sarcoma was conducted. Patients with pathologically confirmed extraskeletal osteosarcoma from 1982 to 2012 were identified and were included in the analysis. Medical records were reviewed for clinical features, treatment, and outcomes.
  
  
  RESULTS
  Fifty-three patients were identified from the database: forty-two presented with localized disease, two presented with metastatic disease, and nine presented with recurrent (local and/or distant) disease. The median patient age at diagnosis was sixty-four years, with a median follow-up time of thirty-four months (range, one to 290 months) for survivors. Of the fifty-three patients who were identified, forty-one had lesions in the extremities, fifty-one had high-grade lesions, forty had lesions >5 cm, and forty-two had deep lesions. For patients presenting with localized disease, the median survival was 45.8 months with a three-year cumulative incidence of death due to disease of 39%. All patients with localized disease were managed with surgical resection of the primary tumor: nineteen with surgery only, ten with adjuvant radiation, five with adjuvant chemotherapy, and eight with both radiation and chemotherapy. Eighteen patients relapsed: two patients had local recurrences, ten patients had distant metastases, and six patients had local recurrences and distant metastases. In log-rank analysis, patients with superficial tumors and negative margins at resection had a higher three-year event-free survival. No significant association of disease-specific or event-free survival was found with the addition of radiation, chemotherapy, or both to surgery.
  
  
  CONCLUSIONS
  For patients presenting with localized extraskeletal osteosarcoma, three-year event-free survival was higher for patients with superficial tumors and negative margins at resection. Radiation and chemotherapeutic treatment were not associated with a lower incidence of death due to disease or a longer event-free survival.
authors.affiliation: Orthopaedic Surgery Service (L.E.C. and J.H.H.), Gastric and Mixed Tumor Service (M.F.B.), Department of Surgery, and Department of Epidemiology and Biostatistics (D.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Choi
authors.affiliation: Orthopaedic Surgery Service (L.E.C. and J.H.H.), Gastric and Mixed Tumor Service (M.F.B.), Department of Surgery, and Department of Epidemiology and Biostatistics (D.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail.
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.affiliation: Orthopaedic Surgery Service (L.E.C. and J.H.H.), Gastric and Mixed Tumor Service (M.F.B.), Department of Surgery, and Department of Epidemiology and Biostatistics (D.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kuk
authors.affiliation: Orthopaedic Surgery Service (L.E.C. and J.H.H.), Gastric and Mixed Tumor Service (M.F.B.), Department of Surgery, and Department of Epidemiology and Biostatistics (D.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. E-mail.
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016019:Survival Analysis