title: A meta-analysis of limb-salvage versus amputation in the treatment of patients with Enneking‡U pathologic fracture osteosarcoma.
abstract: BACKGROUND
  The aim of this meta-analysis was to further explore whether the relapse, 5-year survival and metastasis the same or not between limb-salvage and amputation in the treatment of patients with limited stage Enneking II pathologic fracture osteosarcoma.
  
  
  METHODS
  An electronic search of the Medline, EMBASE and CNKI was done on October 2014. The clinical studies about amputation or limb-salvage surgery in the treatment of patients with limited stage Enneking II pathologic fracture osteosarcoma were searched and reviewed. The effect size of relapse, 5-year survival and metastasis between the amputation and limb-salvage surgery were pooled by stata11.0 software (Stata Corporation, College Station, TX, USA, http://www.stata.com;) using random or fixed effect model. The funnel plot and Egger's line regression test were used for evaluation of publication bias.
  
  
  RESULTS
  A total of 89 studies were identified and seven articles with 200 cases in the limb-salvage surgery group and 84 subjects in the amputation group were finally included in the meta-analysis. The pooled data indicated that no statistical different of risk for developing relapse between limb-salvage and amputation was found relative risk (RR) =1.40, 95% confidence interval (CI): 0.71-2.79, (P = 0.33). The 5-year survival rate of patients underwent limb-salvage surgery was smaller than patients received amputation RR = 1.86, 95%CI: 1.19-2.89, (P = 0.01); the metastasis rate of patients underwent limb-salvage surgery was significant decreased compared with patients received amputation RR = 0.56, 95% CI: 0.34-0.94, (P = 0.03). No publication bias was existed in this meta-analysis.
  
  
  CONCLUSIONS
  Limb-salvage surgery does not increased the risk of relapse compared with amputation in the treatment of patients with limited stage Enneking II pathologic fracture osteosarcoma.
authors.forename: F
authors.initials: F
authors.lastname: Jiang
authors.affiliation: Department of Oncology, Huaihe Hospital Affiliated to Henan University, Kaifeng 475000, PR China.
authors.forename: Y
authors.initials: Y
authors.lastname: Shi
authors.forename: G J
authors.initials: GJ
authors.lastname: Li
authors.forename: F
authors.initials: F
authors.lastname: Zhou
mesh_terms: D000671:Amputation, Surgical / Q000379:methods* / Q000401:mortality; D001859:Bone Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D050723:Fractures, Bone / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D023821:Limb Salvage / Q000379:methods* / Q000401:mortality; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D016879:Salvage Therapy; D015996:Survival Rate