title: The importance of standardized treatment in high-grade osteosarcoma: 30 years of experience from a hospital-based database.
abstract: BACKGROUND
  Treatment of high-grade osteosarcoma remains a major challenge in orthopedic oncology as no major breakthrough in overall survival has occurred in the past 20 years. Due to the rarity of the disease, comparing the results of a single institution to best standard practice needs the establishment of clinical databases. The aim of this study was to report the cumulative 30-years' experience of a single institution and to assess the incidence, survival and prognostic factors of high-grade osteosarcoma using a recently validated, hospital-based database, representing all citizens living in western Denmark, the Aarhus Sarcoma Registry.
  
  
  METHODS
  Between 1979 and 2008, 169 patients were treated at the Sarcoma Centre of Aarhus University Hospital for high-grade osteosarcoma. The incidence was calculated as a WHO age-standardized incidence per million per year. The endpoint was overall survival, analyzed by the Kaplan-Meier method and log-rank. Possible prognostic factors were analyzed by the uni- and multivariate Cox proportional hazard method.
  
  
  RESULTS
  The incidence of high-grade osteosarcoma in western Denmark from 1979 to 2008 was 2.7/million inhabitants/year. The five-year overall survival was 42% (95% CI 34; 49) for the whole cohort of patients with high-grade osteosarcoma and 54% (95% CI 43; 64) for patients with localized disease treated with wide excision and chemotherapy. For patients treated with curative intent, no soft tissue extension, treatment with sufficient surgical margin and standard chemotherapy, as well as a high degree of necrosis after chemotherapy were all independent prognostic factors for overall survival.
  
  
  CONCLUSIONS
  The data from this hospital-based, validated database confirms the relevance of the known prognostic factors of high-grade osteosarcoma and emphasizes the importance of adequate surgical margins and chemotherapy.
authors: Department of Experimental Clinical Oncology, Sarcoma Centre, Aarhus University Hospital , Denmark.
authors: Ninna
authors: N
authors: Aggerholm-Pedersen
authors: Katja
authors: K
authors: Maretty-Nielsen
authors: Johnny
authors: J
authors: Keller
authors: Steen
authors: S
authors: Baerentzen
authors: Henrik
authors: H
authors: Schrøder
authors: Peter Holmberg
authors: PH
authors: Jørgensen
authors: Bjarne Hauge
authors: BH
authors: Hansen
authors: Ole Steen
authors: OS
authors: Nielsen
authors: Akmal
authors: A
authors: Safwat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000592:standards; D016208:Databases, Factual; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D023821:Limb Salvage / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D012516:Osteosarcoma / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents