Influence of bony resection margins and surgicopathological factors on outcomes in limb-sparing surgery for extremity osteosarcoma.
Limb-sparing surgery for osteosarcoma requires taking wide bony resection margins while maximizing preservation of native bone and joint. However, the optimal bony margin and factors associated with recurrence and survival outcomes in these patients are not well established.



We conducted a retrospective review of outcomes in children and adolescents with newly diagnosed osteosarcoma from 1986 to 2012, where bony resection margins for limb-sparing surgeries were decreased serially from 5 to 1.5 cm. The association between bony margins and other surgicopathological factors with survival and recurrence outcomes was determined.



In 181 limb-sparing surgeries in 173 patients, planned and actual bony resection margins were not significantly associated with local recurrence-free survival (LRFS), event-free survival (EFS), and overall survival (OS)-at median 5.8 years follow-up, decreasing planned bony resection margins from 5 to 1.5 cm did not significantly decrease survival outcomes. Multivariable analysis showed that the presence of distant metastases at diagnosis was associated with decreased LRFS, EFS, and OS (P = 0.002, 0.005, and <0.0001, respectively). Post-chemotherapy tumor necrosis ≤90% was associated with decreased EFS and OS (P = 0.001 and 0.022, respectively). Earlier years of treatment and pathologic fractures were associated with decreased OS only (P = 0.018 and 0.008, respectively); previous cancer history and male gender were associated with decreased EFS only (P = 0.043 and 0.023, respectively).



We did not observe significant increase in adverse survival outcomes with reduction of longitudinal bony resection margins to 1.5 cm. Established prognostic factors, particularly histologic response to chemotherapy and metastases at diagnosis, remain relevant in limb-sparing patients. Pediatr Blood Cancer 2015;62:246-251. © 2014 Wiley Periodicals, Inc.
Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.
Amos H P
0000-0001-8333-1486
AH
Loh
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Huiyun
H
Wu
Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Armita
A
Bahrami
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.|Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Fariba
F
Navid
Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee.
M Beth
MB
McCarville
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Chong
C
Wang
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Jianrong
J
Wu
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Michael W
MW
Bishop
Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Najat C
NC
Daw
Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
Michael D
MD
Neel
Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.
Bhaskar N
BN
Rao
D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005121:Extremities / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D059351:Organ Sparing Treatments / Q000379:methods*; D012516:Osteosarcoma / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
limb salvage; neoplasm recurrence, local; osteosarcoma; osteotomy; resection margin