Improving outcomes in paediatric high-grade osteosarcoma: Insights from a retrospective survival study

High-grade osteosarcoma is the most prevalent primary malignant bone tumor in children and adolescents. Despite advancements in chemotherapy and surgical techniques, survival rates have stagnated, particularly in patients presenting with metastases or poor chemotherapeutic response. This study aims to evaluate survival outcomes and identify prognostic factors influencing overall survival in pediatric osteosarcoma patients treated at a tertiary care center.

This retrospective cohort study included patients ≤18 years with histologically confirmed high-grade osteosarcoma treated with curative intent between January 2018 and January 2025. Cases with secondary, extraskeletal, or palliative indications were excluded. Data from the institutional bone tumor registry included demographic details, tumor characteristics, treatment modalities, and survival status. Statistical analysis involved chi-squared and t-tests, with Cox proportional hazards modeling used to assess associations between clinical variables and survival.

Eighteen patients (mean age 13.3 years; mean follow-up 16.7 months) met inclusion criteria. Neoadjuvant chemotherapy was significantly associated with improved survival (p = 0.043). While variables such as surgical type, margin status, chemotherapy response, and metastasis at presentation did not reach statistical significance, favourable trends were observed with limb-salvage surgery, wide margins, and the OGS12 chemotherapy regimen. Cox regression revealed lower mortality hazard ratios for neoadjuvant chemotherapy (HR 0.50) and limb-salvage surgery (HR 0.32), though not statistically significant.

Neoadjuvant chemotherapy appears to enhance survival in pediatric osteosarcoma. Though limited by sample size, this study supports its prognostic value and underscores the need for larger, prospective studies to validate these findings and inform individualized treatment strategies.