Fibular osteosarcomas: contaminated margins may not impact survival

The fibula is an expendable bone which when affected by primary malignancy may simplify treatment and improve outcome. This concept was questioned previously in a study showing a high rate of inadequate margins at surgical resection. We asked whether margin status and other dependent variables affect survival. We analyzed the charts of 36 patients with fibular osteosarcomas treated from 1919 to 2000. We estimated survival by the Kaplan-Meier method and the prognostic significance of dependent variables, especially marginal status, with univariate association using Cox proportional hazard regression. The survival of patients with fibular osteosarcomas was limited, with a median survival of 5 years 4 months after diagnosis. At 5 years, 16 patients died of their disease. Sixteen patients were still alive at 10 years followup. The margin status at surgery was not associated with survival. A higher tumor grade at diagnosis, surgical treatment with above-knee amputation, and occurrence of metastasis were associated with poorer long-term survival. The survival of patients with fibular osteosarcomas was not better than with osteosarcomas arising in other locations. A marginal resection surprisingly did not impact on overall survival, although we had a limited dataset and heterogeneous treatment protocols.