Chondrosarcoma of the Proximal Humerus: Does the Margin Affect Survival?

Area of Science:

• Orthopedic Oncology
• Bone Tumors
• Surgical Pathology

Background:

• Chondrosarcoma (CS) is the second most common primary malignant bone tumor.
• Effective treatment relies heavily on surgical intervention due to limited chemotherapy and radiotherapy options.
• Tumor grade impacts disease-specific survival (DSS), and resection margins influence local recurrence-free survival (LRFS).

Purpose of the Study:

• To investigate factors influencing local and systemic prognoses for conventional central CS of the proximal humerus.
• To analyze the relationship between tumor grade, local recurrence, and survival outcomes.
• To guide surgical management strategies based on tumor characteristics.

Main Methods:

• Multi-center, retrospective study involving 110 patients treated between 1995 and 2020.
• Inclusion of conventional central CS of the proximal humerus from three international collaborative sarcoma centers.
• Analysis of tumor grade, local recurrence (LR), and disease-specific mortality (DSM).

Main Results:

• Tumor grade was a significant factor for LRFS (p < 0.001) and DSS (p < 0.001).
• Grade 1 proximal humeral CS showed no local recurrence or disease-specific mortality.
• Grade 2 CS exhibited indolent behavior with a higher LR rate than grade 1 but low mortality and high DSS; LR did not impact DSS.
• Grade 3 CS demonstrated aggressive behavior, consistent with other skeletal sites.

Conclusions:

• Proximal humeral grade 1 CS behaves like a benign tumor.
• Grade 2 CS of the proximal humerus warrants surgical management focused on function preservation with adequate margins, as local recurrence does not significantly affect survival.
• Grade 3 proximal humeral CS requires aggressive surgical management, including en bloc resection with clear margins, to prevent local recurrence.