title: Prognostic factors and treatment results of high-grade osteosarcoma in norway: a scope beyond the "classical" patient.
abstract: Purpose. A retrospective study of prognostic factors and treatment outcome of osteosarcoma (OS) during modern chemotherapy era with focus on patients with primary metastatic disease, nonextremity localisation, or age >40 years (nonclassical OS). Methods. A nationwide cohort, comprising 424 high-grade Norwegian bone OS patients, was based on registry sources supplemented with clinical records from hospitals involved in sarcoma management between 1975 and 2009. Results. Only 48% were younger patients with tumour in the extremities and without metastasis at diagnosis (classical OS). A considerable discrepancy in survival between classical and nonclassical OS was observed: 61% versus 26% 10-year sarcoma specific survival. Twice as many of the former received both adequate surgery and chemotherapy compared to the latter. This could only partly explain the differences in survival due to inherent chemoresistance in primary metastatic disease and a higher rate of local relapse among patients with axial tumours. Metastasis at diagnosis, increased lactate dehydrogenase, age > 40 years, and tumour size above median value were all adverse prognostic factors for overall survival. Conclusion. We confirm a dramatic difference in outcome between classical and nonclassical high-grade OS patients, but treatment variables could only partly explain the dismal outcome of the latter.
authors.affiliation: Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway ; The Norwegian Cancer Registry, 0304 Oslo, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Berner
authors.affiliation: Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway.
authors.forename: Kirsten Sundby
authors.identifier: 0000-0002-2126-8255
authors.initials: KS
authors.lastname: Hall
authors.affiliation: Department of Oncology, Haukeland University Hospital, 5020 Bergen, Norway.
authors.forename: Odd R
authors.initials: OR
authors.lastname: Monge
authors.affiliation: Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424 Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Weedon-Fekjær
authors.affiliation: Department of Orthopedics, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway.
authors.forename: Olga
authors.initials: O
authors.lastname: Zaikova
authors.affiliation: Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway.
authors.forename: Øyvind S
authors.initials: ØS
authors.lastname: Bruland