Prevalence and risk factors of distant metastasis among Chinese osteosarcoma patients: a systematic review and...

This study aims to conduct a meta-analysis integrating multiple literature sources to explore the risk factors for distant metastasis (DM) in osteosarcoma (OS).

We searched PubMed, Cochrane Library, Embase, and Web of Science (up to August 16, 2025) for observational studies on risk factors for DM in OS. A meta-analysis was conducted according to the PRISMA guidelines. After data extraction, STATA 15.0 was used to calculate the pooled odds ratio (OR) values and 95% confidence interval (CI).

This meta-analysis included 12 studies involving 16,656 patients, of which 2,540 cases had DM, with a prevalence of 15.24%. The meta-analysis results showed that the risk factors for DM in OS were associated with male gender [OR = 0.71, 95%CI (0.59, 0.84), P < 0.001], T2 [OR = 2.26, 95%CI (1.85, 2.75), P < 0.001], T3 [OR = 4.37, 95%CI (2.84, 6.73), P < 0.001], TX [OR = 2.72, 95%CI (1.31, 5.63), P = 0.007], N1 [OR = 4.05, 95%CI (2.29, 7.19), P < 0.001], NX [OR = 2.70, 95%CI (1.40, 5.19), P = 0.003], tumor size (> 10 cm) [OR = 3.37, 95%CI (2.17, 5.22), P < 0.001], tumor size (unknown) [OR = 3.81, 95%CI (2.60, 5.58), P < 0.001], primary site surgery [OR = 0.32, 95%CI (0.17, 0.60), P < 0.001], and bone metastases [OR = 5.81, 95%CI (4.09, 8.24), P < 0.001], but not with tumor grade (low, unknown), tumor size (5-10 cm), axial bone, or radiotherapy.

This and previous studies demonstrate that DM in OS is influenced by multiple known risk factors, most of which can be identified during preoperative assessment. The crucial step lies in translating these preoperative insights into concrete postoperative preventive actions. This approach holds significant value for improving clinical management quality and formulating individualized postoperative follow-up and intervention plans. These findings, derived from clinical data within a Chinese population, are particularly applicable to the management of OS patients in China, offering tailored guidance for this demographic.