title: Clinical Outcome and Survival of Osteosarcoma Patients in Cipto Mangunkusumo Hospital: Limb Salvage Surgery versus Amputation.
abstract: OBJECTIVE
  to analyze the outcome and survival rate of osteosarcoma patients in our hospital as well as the factors affecting prognosis and functional outcome.
  
  
  METHODS
  this is a retrospective cohort study of osteosarcoma patients in Cipto Mangunkusumo Hospital underwent limb salvage surgery (LSS), amputation, LSS + amputation, and refused surgery from year 1995 to 2014. The surgical decision was based on patient's age, staging, location, neurovascular involvement, Huvos type, functional demand, patient preference, and general condition. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score with the maximum score of 30.
  
  
  RESULTS
  subjects consisted of 80 male and 52 female aged 4 to 61 year-old. They underwent limb salvage surgery (LSS) (n=37), amputation (n=42), LSS + amputation (n=2), and refused surgery (n=51). Overall 5-year cumulative survival rate was 14.6%. The 5-year survival rate for each group; LSS, amputation, combined LSS and amputation, and refused surgery was 34.8%; 15.9%; 0%; and 0%, respectively. Patients with tumor size <8 cm tend to underwent LSS compared to amputations (60.7% vs 39.3%, p=0.046). Local recurrence-free survival for LSS and amputation was 96.2% and 86.5% respectively (p=0.586). MSTS score was higher in LSS than amputation group (25.0 vs 18.5, p=0.011).
  
  
  CONCLUSIONS
  LSS had higher survival rate than amputation in osteosarcoma patients who were treated in Cipto Mangunkusumo Hospital. MSTS functional score in the LSS group was higher than amputation group.
authors.affiliation: Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. fauzi.kamal@ui.ac.id.
authors.forename: Achmad Fauzi
authors.initials: AF
authors.lastname: Kamal
authors.forename: Heru
authors.initials: H
authors.lastname: Widyawarman
authors.forename: Kurniadi
authors.initials: K
authors.lastname: Husodo
authors.forename: Errol Untung
authors.initials: EU
authors.lastname: Hutagalung
authors.forename: Wulyo
authors.initials: W
authors.lastname: Rajabto
mesh_terms: D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000401:mortality* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007214:Indonesia; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Osteosarcoma; amputation; limb-salvage surgery