Surgical Margin Analysis in Osteosarcoma: Impact on Survival and Local Control

Area of Science:

• Orthopedic Oncology
• Surgical Pathology
• Cancer Research

Background:

• Surgical margin quality is a known prognostic factor in sarcomas.
• The prognostic significance of margin width in osteosarcoma, particularly soft tissue margins, remains debated.
• Extraosseous margin assessment is critical due to potential proximity to neurovascular structures.

Purpose of the Study:

• To evaluate the impact of soft tissue surgical margin width on local recurrence and overall survival in high-grade osteosarcoma patients.
• To determine if a narrow extraosseous margin (<1 mm) influences oncological outcomes.
• To clarify the role of soft tissue margins in high-grade osteosarcoma management.

Main Methods:

• Retrospective, single-center study of 75 high-grade osteosarcoma patients.
• Standardized neoadjuvant chemotherapy followed by surgical resection.
• Stratification into three groups based on extraosseous margin width: <1 mm, 1-5 mm, and ≥5 mm.
• Analysis of local recurrence and overall survival using Kaplan-Meier, log-rank, and Cox regression.

Main Results:

• Local recurrence observed in 9% of patients.
• A trend towards significance (p=0.074) for overall margin comparison.
• Significantly higher recurrence rates in the <1 mm margin group compared to wider margins (p=0.024).
• No significant difference in overall survival across margin groups (p=0.896).

Conclusions:

• Very close soft tissue margins (<1 mm) are associated with an increased risk of local recurrence in high-grade osteosarcoma.
• Surgical margin width in the soft tissue component does not appear to influence overall survival in this cohort.
• These findings highlight the importance of achieving adequate soft tissue margins to minimize local recurrence risk in osteosarcoma.