title: Developing a prognostic model for patients with localized osteosarcoma treated with uniform chemotherapy protocol without high dose methotrexate: A single-center experience of 237 patients.
abstract: BACKGROUND
  Studies of baseline prognostic factors in patients with localized osteosarcoma treated without high dose methotrexate are limited.
  
  
  METHODS
  This is single-institutional review of localized osteosarcoma patients treated without high dose methotrexate between June 2003-December 2012. A multivariate analysis of impact of baseline and treatment characteristics on outcome was performed and a prognostic model was developed based solely on baseline factors for predicting event-free survival (EFS) and overall survival (OS).
  
  
  RESULTS
  Of 237 patients with median age of 17 years (range 2-66 yrs), neoadjuvant chemotherapy (NACT) was administered in 220 (92.82%) patients. Post NACT, 200/237 (84.38%) patients underwent surgery. At 30 months median follow-up, 5-year EFS and OS were 36.60 ± 0.03%, and 50.33 ± 0.04%, respectively. In multivariate analysis, baseline factors including duration of symptom >4 months (P < 0.001) and good performance status (PS) (P < 0.001) predicted better EFS whereas good PS (P = 0.01) and normal serum alkaline phosphatase (SAP) (P = 0.03) predicted better OS. The 5-year EFS without any risk factor (symptom duration <4 months, PS>1) was 58.7 ± 0.1%, with either one factor 31.5 ± 0.1% and with both factors 21.9 ± 0.1%. The 5-year OS without any risk factor (PS>1, elevated SAP) was 66.9 ± 0.1%, with either one factor 57.9 ± 0.1% and with both factors 25.6 ± 0.1%.
  
  
  CONCLUSIONS
  This prognostic model assists in categorizing risk-groups within localized osteosarcoma.
authors.affiliation: Department of Medical Oncology, New Delhi.|Dr. B.R.A. Institute Rotary Cancer Hospital, New Delhi.|All India Institute of Medical Sciences, New Delhi.
authors.forename: Vijayamurugan
authors.initials: V
authors.lastname: Nataraj
authors.affiliation: Department of Medical Oncology, New Delhi.|Dr. B.R.A. Institute Rotary Cancer Hospital, New Delhi.|All India Institute of Medical Sciences, New Delhi.
authors.forename: Atul
authors.initials: A
authors.lastname: Batra
authors.affiliation: All India Institute of Medical Sciences, New Delhi.|Department of Orthopedics, New Delhi.
authors.forename: Shishir
authors.initials: S
authors.lastname: Rastogi
authors.affiliation: All India Institute of Medical Sciences, New Delhi.|Department of Orthopedics, New Delhi.
authors.forename: Shah Alam
authors.initials: SA
authors.lastname: Khan
authors.affiliation: All India Institute of Medical Sciences, New Delhi.|Department of Pathology, New Delhi.
authors.forename: Mehar Chand
authors.initials: MC
authors.lastname: Sharma
authors.affiliation: All India Institute of Medical Sciences, New Delhi.|Department of Biostatistics, New Delhi.
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Vishnubhatla
authors.affiliation: Department of Medical Oncology, New Delhi.|Dr. B.R.A. Institute Rotary Cancer Hospital, New Delhi.|All India Institute of Medical Sciences, New Delhi.
authors.forename: Sameer
authors.initials: S
authors.lastname: Bakhshi
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D002945:Cisplatin / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D012516:Osteosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide; D008727:Methotrexate
keywords: localized osteosarcoma; neoadjuvant chemotherapy; outcome; prognostic factors; prognostic model