Characteristic
No. of patients
%
Entire population
529
100
Age, years; mean [SD]
20.0 [12.9]
≤12
134
25.3
13–19
227
42.9
20–39
121
22.9
40–
47
8.9
Sex
Male
326
61.6
Female
203
38.4
Tumor size, cm: mean [SD]
9.6 [4.1]
≤8
237
44.8
>8
292
55.2
Tumor site
Distal extremitya
42
7.9
Distal femur
251
47.4
Proximal tibia/fibula
151
28.5
Proximal humerus
47
8.9
Proximal femur
38
7.2
Pathologic fracture
No
489
92.4
Yes
40
7.6
Histologic response (tumor necrotic rate, %)
Grade 1 (<50)
133
25.1
Grade 2 (50–89)
161
30.4
Grade 3 (90–99)
169
31.9
Grade 4 (100)
66
12.5
Type of surgery
Limb salvage
420
79.4
Amputation
71
13.4
Unknown
38
7.2
Surgical margin
Negative
193
36.5
Positive
1
0.2
Unknown
335
63.3
4.3 Survival and Prognostic Factors
Distant metastasis and tumor-related death occurred in 194 patients and 106 patients, respectively. The data for metastasis-free survival (MFS) and overall survival (OAS) estimated using the Kaplan-Meier method are shown Fig. 4.1a, b. The 3-, 5-, and 10-year MFS rates and OAS rates for the 529 patients were 70 %, 64 %, and 62 % and 88 %, 83 %, and 77 %, respectively. The univariate associations of the various factors with the MFS and OAS rates determined using Kaplan-Meier plots are shown in Figs. 4.2a–g and 4.3a–g, respectively.
Fig. 4.1
Kaplan-Meier plots for the patients overall (MFS (a) and OAS (b))
Fig. 4.2
Kaplan-Meier survival plots stratified by predictor variables on MFS: (a) age (≤12, 13–19, 20–39, ≥40 year), (b) sex, (c) tumor size (≤8 cm, >8 cm), (d) tumor site (distal extremity, distal femur, proximal tibia/fibula, proximal humerus, proximal femur), (e) pathologic fracture, (f) histologic response to preoperative chemotherapy, and (g) type of surgery (limb salvage, amputation)
Fig. 4.3
Kaplan-Meier survival plots stratified by predictor variables on OAS: (a) age (≤12, 13–19, 20–39, ≥40 year), (b) sex, (c) tumor size (≤8 cm, >8 cm), (d) tumor site (distal extremity, distal femur, proximal tibia/fibula, proximal humerus, proximal femur), (e) pathologic fracture, (f) histologic response to preoperative chemotherapy, and (g) type of surgery (limb salvage, amputation)
Table 4.2 shows the univariate and multivariate Cox proportional hazard models for MFS and OAS. Multivariate analyses demonstrated significant associations between distant metastasis and a patient age of 13–19 years (hazard ratio [HR], 1.56; 95 % confidence interval [CI], 1.07–2.29; P = 0.022) or ≥40 years (HR, 2.13; 95 % CI, 1.26–3.59; P = 0.005), tumor size >8 cm (HR, 1.58; 95 % CI, 1.17–2.14; P = 0.003), tumor location in the proximal humerus (HR, 2.86; 95 % CI, 1.32–6.19; P = 0.008), presence of pathologic fracture (HR, 1.75; 95 % CI, 1.10–2.78; P = 0.018), and tumor necrotic rate (50–89 % (HR, 0.66; 95 % CI, 0.47–0.94; P = 0.021), 90–99 % (HR, 0.53; 95 % CI, 0.36–0.77; P = 0.001), and 100 % (HR, 0.36; 95 % CI, 0.20–0.65; P = 0.001)). Moreover, multivariate analyses demonstrated significant associations between tumor-related death and a patient age of 13–19 years (HR, 1.76; 95 % CI, 1.00–3.08; P = 0.048) or ≥40 years (HR, 3.91; 95 % CI, 1.96–7.78; P < 0.001), tumor size >8 cm (HR, 1.61; 95 % CI, 1.06–2.46; P = 0.026), tumor site (distal femur (HR, 8.48; 95 % CI, 1.17–61.68; P = 0.035), proximal tibia/fibula (HR, 10.94; 95 % CI, 1.49–80.32; P = 0.019), proximal humerus (HR, 9.42; 95 % CI, 1.20–73.89; P = 0.033), and proximal femur (HR, 14.07; 95 % CI, 1.83–108.16; P = 0.011)), presence of pathologic fracture (HR, 2.72; 95 % CI, 1.56–4.74; P < 0.001), and tumor necrotic rate (50–89 % (HR, 0.56; 95 % CI, 0.35–0.90; P = 0.015), 90–99 % (HR, 0.48; 95 % CI, 0.29–0.79; P = 0.004), and 100 % (HR, 0.30; 95 % CI, 0.13–0.68; P = 0.004)).
Table 4.2
Cox proportional hazards models for MFS and OAS
MFS | OAS | |||||||
---|---|---|---|---|---|---|---|---|
Univariate analysis | Multivariate analysis | Univariate analysis | Multivariate analysis | |||||
Hazard ratio | P value | Hazard ratio | P value | Hazard ratio | P value | Hazard ratio | P value | |
(95 % CI) | (95 % CI) | (95 % CI) | (95 % CI) | |||||
Age (year) | ||||||||
≤12 | Reference | Reference | Reference | Reference | ||||
13–19 | 1.51 (1.04–2.21) | 0.032 | 1.56 (1.07–2.29) | 0.022 | 1.71 (0.98–2.97) | 0.059 | 1.76 (1.00–3.08) | 0.048 |
20–39 | 1.17 (0.75–1.82)
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