A meta-analysis of prognostic factors of osteosarcoma.

OBJECTIVE: To systemically evaluate the factors influencing the prognosis of osteosarcoma.

MATERIALS AND METHODS: Case-control studies (sample size>100) investigating the factors influencing the prognosis of osteosarcoma published from 1st January 1980 to 1st February 2019 were searched in the databases, including PubMed, Embase, and CBM. The meta-analysis was conducted within the Review Manager 5.3 software.

RESULTS: 22 studies were included. The 5-year overall survival (OS) of male patients was significantly lower than that of female patients (OR=0.84, 95% CI=0.76-0.93). There was no significant statistical difference in 5-year OS between the adolescent group (≤14 years old) and the adult group (>14 years old) (OR=0.88, 95% CI=0.68-1.14). Before standardized chemotherapy, which was started in 2000, the 5-year OS of patients receiving surgery and chemotherapy was significantly higher than patients only receiving surgery (OR=3.20, 95% CI=2.30-4.46). After 2000, the 5-year OS of patients receiving standardized chemotherapy was significantly higher than those undergoing non-standardized chemotherapy (OR=2.17, 95% CI=1.77-2.67). The 5-year OS of the limb-salvage surgery group was higher than that of the amputation surgery group (OR=2.17, 95% CI=1.77-2.67). The 5-year OS of patients with a good response to chemotherapy (Huvos III+IV) was higher than that of patients with poor response to chemotherapy (Huvos I+II) (OR=2.45, 95% CI=2.10-2.87). Patients without bone metastasis had significantly better 5-year OS than those with bone metastasis at initial diagnosis (OR=0.2, 95% CI=0.11-0.39).

CONCLUSIONS: The prognosis of male osteosarcoma patients was slightly worse than that of female patients. Surgery plus standardized chemotherapy can improve the 5-year OS of osteosarcoma patients. Patients who had undergone limb-salvage surgery had a better prognosis. Poor response to chemotherapy and bone metastasis had a negative influence on the prognosis of osteosarcoma.