Does chemotherapy improve the prognosis in patients with jaw osteosarcoma? A systematic review and meta-analysis

Osteosarcoma, a rare tumour, primarily affects the long bones in young individuals. However, it can also involve the jaw, presenting as jaw osteosarcoma (JOS), which is characterized by higher local recurrence than metastasis. While advances in chemotherapy have contributed to the treatment of osteosarcoma, its role in JOS remains debated. This study was performed to evaluate the effects of chemotherapy on survival outcomes. A systematic search for studies published between 1990 and 2024 was conducted using PubMed, Embase, and Google Scholar. Eligible studies reported survival data for histologically confirmed JOS cases. Kaplan-Meier analysis and Cox regression were performed to assess survival rates and prognostic factors. The analysis included 330 patients from 20 studies. The 5-year overall survival rate was 37.1% and the 10-year rate was 10.5%. Age (≥40 years), surgical margin status (positive), and tumour size (≥5 cm) were identified as significant prognostic factors (worse prognosis). Importantly, patients with high-grade JOS treated with both surgery and chemotherapy (versus surgery without chemotherapy) demonstrated improved survival (hazard ratio 0.500, 95% confidence interval 0.262-0.954, P = 0.035). Overall, chemotherapy provided significant benefit in high-grade cases. This study provides valuable insights for refining treatment protocols for this rare tumour type.