title: Prognostic factors for survival in patients with high-grade osteosarcoma using the Surveillance, Epidemiology, and End Results (SEER) Program database.
abstract: BACKGROUND
  The current study aims to determine cause-specific survival in patients with high-grade osteosarcoma while reporting risk factors for decreased survival out to 10 years.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify all patients diagnosed with high-grade osteosarcoma from 1991 to 2010. Patient, tumor, and county-level socioeconomic measures were analyzed to determine prognostic factors for survival.
  
  
  RESULTS
  Cause-specific 10-year survival for patients with local/regional disease at the time of diagnosis was 65.8%, compared to 24.0% for patients with metastatic disease. Multivariate analysis revealed metastatic disease at presentation, age≥60 years, male sex, axial location, and size≥10cm as independent risk factors for decreased cause-specific survival at 10 years. Patients with the lowest socioeconomic status had a disproportionate frequency of metastatic disease and large tumors at presentation as compared to more affluent patients.
  
  
  CONCLUSIONS
  Patients with high-grade osteosarcoma have decreased cause-specific survival at 10 years when metastatic at diagnosis, patient age≥60 years, male sex, axial tumor location, and tumors measuring≥10cm. Patients living in low socioeconomic counties present more frequently with metastatic disease and large tumors. Public health efforts should focus on identifying patients with osteosarcoma prior to metastasis.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA. Electronic address: kyle-duchman@uiowa.edu.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Duchman
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA. Electronic address: yubo-gao@uiowa.edu.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA. Electronic address: benjamin-j-miller@uiowa.edu.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D012516:Osteosarcoma / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class
keywords: Bone neoplasms/mortality; Risk factors; SEER Program; Sarcoma, Osteosarcoma/mortality; Survival analysis