Adverse impact of regional lymph node involvement in osteosarcoma

Area of Science:

• Oncology
• Surgical Pathology
• Cancer Epidemiology

Background:

• Osteosarcoma typically metastasizes hematogenously.
• Regional lymph node involvement in osteosarcoma is infrequently reported.
• This study examines the incidence and prognostic impact of regional lymph node involvement at diagnosis.

Purpose of the Study:

• To determine the incidence of regional lymph node involvement in osteosarcoma at diagnosis.
• To characterize patients with osteosarcoma and regional lymph node involvement.
• To evaluate the impact of regional lymph node involvement on patient survival.

Main Methods:

• Utilized the Surveillance Epidemiology and End Results (SEER) database (1973-2009).
• Included 2748 cases of high-grade osteosarcoma with data on regional lymph node status.
• Employed chi-squared and t-tests for demographic comparisons, Kaplan-Meier for survival analysis, and Cox proportional hazards models for multivariate analysis.

Main Results:

• Regional lymph node involvement was identified in 2.7% of patients (19 pathologically confirmed).
• Patients with node involvement were more likely to have extraskeletal tumors, distant metastases, and tumors outside the lower extremity.
• Five-year overall survival was significantly lower for patients with regional node involvement (10.9%) compared to those without (54.3%; p<0.0001).
• Regional node involvement remained an independent predictor of inferior survival (HR 2.05, p<0.0001) in multivariate analysis.

Conclusions:

• Regional lymph node involvement is a significant adverse prognostic factor in osteosarcoma.
• This factor's impact on survival is independent of metastatic status, extraskeletal origin, age, and tumor site.
• Findings underscore the importance of assessing regional lymph node status in osteosarcoma patients.