title: Does a pathological fracture affect the prognosis in patients with osteosarcoma of the extremities? : a systematic review and meta-analysis.
abstract: Opinion remains divided as to whether the development of pathological fracture affects the prognosis of patients with an osteosarcoma of the extremities. We conducted a comprehensive systematic review and meta-analysis of papers which reported the outcomes of osteosarcoma patients with and without a pathological fracture. There were eight eligible papers for final analysis which reported on 1713 patients, of whom 303 (17.7%) had a pathological fracture. The mean age for 1464 patients in six studies was 23.2 years old (2 to 82). The mean follow-up for 1481 patients in seven studies was 90.1 months (6 to 240). The pooled estimates of local recurrence rates in osteosarcoma patients with and without pathological fractures were 14.4% (8.7 to 20.0) versus 11.4% (8.0 to 14.8). The pooled estimate of relative risk was 1.39 (0.89 to 2.20). The pooled estimates of five-year event-free survival rates in osteosarcoma patients with and without a pathological fracture were 49.3% (95% CI 43.6 to 54.9) versus 66.8% (95% CI 60.7 to 72.8). The pooled estimate of relative risk was 1.33 (1.12 to 1.59). There was no significant difference in the rate of local recurrence between patients who were treated by amputation or limb salvage. The development of a pathological fracture is a negative prognostic indicator in osteosarcoma and is associated with a reduced five-year event-free survival and a possibly higher rate of local recurrence. Our findings suggest that there is no absolute indication for amputation, as similar rates of local recurrence can be achieved in patients who are carefully selected for limb salvage.
authors.affiliation: National University Health System, Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore.
authors.forename: A A
authors.initials: AA
authors.lastname: Salunke
authors.affiliation: National University Health System, Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: National University of Singapore, Yong Loo Lin School of Medicine, 10 Medical Drive, 117597, Singapore.
authors.forename: J H
authors.initials: JH
authors.lastname: Tan
authors.affiliation: National University Health System, Department of Hand and Reconstructive Microsurgery, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore.
authors.forename: X
authors.initials: X
authors.lastname: Chen
authors.affiliation: National University of Singapore, Yong Loo Lin School of Medicine, 10 Medical Drive, 117597, Singapore.
authors.forename: L W
authors.initials: LW
authors.lastname: Khin
authors.affiliation: National University Health System, Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 11, 119228, Singapore.
authors.forename: M E
authors.initials: ME
authors.lastname: Puhaindran
mesh_terms: D001859:Bone Neoplasms / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D003131:Combined Modality Therapy; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D014943:Global Health; D006801:Humans; D015994:Incidence; D012516:Osteosarcoma / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D015996:Survival Rate / Q000639:trends
keywords: Amputation; Event-free survival; Limb salvage; Local recurrence; Osteosarcoma; Pathological fracture