title: Osteosarcoma in Asian Populations Over the Age of 40 Years: A Multicenter Study.
abstract: BACKGROUND
  Elderly patients with osteosarcoma (OSA) are no longer uncommon; however, many questions remain regarding this population. We investigated the clinicopathological characteristics and prognostic factors of OSA in an Asian population over the age of 40 years.
  
  
  METHODS
  This was a multi-national, multi-institutional study by the Eastern Asian Musculoskeletal Oncology Group (EAMOG).
  
  
  RESULTS
  A total of 232 patients were enrolled (116 males and 116 females), with a median age of 50 years at diagnosis; 25 (10.8 %) patients exhibited initial metastasis. Median follow-up was 52 months for survivors. We observed 102 osteolytic and mixed radiographic findings for 173 lesions. Histological subtypes other than osteoblastic type were frequent. Radiation-associated OSA was seen in seven patients, with a 5-year overall survival (OS) of 16.7 %. No Paget's OSA was observed. High-grade spinopelvic OSA was seen in 29 (12.5 %) patients. The 5-year OS was 59.4 % in patients without initial metastasis and 45.2 % in patients with spinopelvic OSA. While surgery and initial metastasis were common prognostic factors for OS, chemotherapy was not. Histologic response to neoadjuvant chemotherapy was poor in 61 of 83 patients.
  
  
  CONCLUSIONS
  This study revealed distinct clinicopathological features of OSA patients over 40 years of age compared with younger patients, such as the high incidence of axial tumors, common osteolytic and mixed radiographic findings, the high frequency of unusual histologic subtypes, and poor prognosis. Contrary to Western elderly patients with OSA, there was no Paget's OSA in this study, which may result in a lower incidence of secondary OSA. Prognostic factor analyses demonstrated chemotherapy did not influence OS.
authors: Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon-si, Gyeonggi-do, Republic of Korea.
authors: Min Wook
authors: MW
authors: Joo
authors: Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Seung Han
authors: SH
authors: Shin
authors: Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon-si, Gyeonggi-do, Republic of Korea.
authors: Yong-Koo
authors: YK
authors: Kang
authors: Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan.
authors: Akira
authors: A
authors: Kawai
authors: Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Han Soo
authors: HS
authors: Kim
authors: Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Apichat
authors: A
authors: Asavamongkolkul
authors: Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul, Korea.
authors: Dae-Geun
authors: DG
authors: Jeon
authors: Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea.
authors: Jae Do
authors: JD
authors: Kim
authors: Department of Orthopedic Oncology Surgery, Beijing Ji Shui Tan Hospital, Beijing, China.
authors: Xiaohui
authors: X
authors: Niu
authors: Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, Kanazawa, Japan.
authors: Hiroyuki
authors: H
authors: Tsuchiya
authors: Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, India.
authors: Ajay
authors: A
authors: Puri
authors: Tumor Service, Department of Orthopedics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
authors: Edward H M
authors: EH
authors: Wang
authors: Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea.
authors: So Hak
authors: SH
authors: Chung
authors: Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. ygchung@catholic.ac.kr.
authors: Yang-Guk
authors: YG
authors: Chung
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D044466:Asian People; D001859:Bone Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D001842:Bone and Bones; D017024:Chemotherapy, Adjuvant; D005260:Female; D005269:Femur; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009381:Neoplasms, Radiation-Induced / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D012516:Osteosarcoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D010384:Pelvic Bones; D011379:Prognosis; D012189:Retrospective Studies; D012447:Sacrum; D013125:Spinal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D013977:Tibia
chemical_list: D000970:Antineoplastic Agents