軟骨肉腫における病的骨折の有害な予後因子：系統的レビュー、メタアナリシス、および施設別症例シリーズの結果

Pathological fractures are recognized as a potential, adverse prognostic factor in primary bone sarcomas. While some studies suggest higher recurrence rates and reduced survival, robust data specific to chondrosarcoma (CS) remain limited. This study evaluates the prognostic relevance of pathological fractures (PF) in CS patients.

A systematic review and meta-analysis were conducted according to PRISMA guidelines. Eligible studies included patients with CS of the bone, with comparative groups based on fracture status and oncological outcomes. Study design, quality, and endpoints were assessed, and pooled meta-analysis was conducted. Additionally, clinical data from an institutional cohort was analyzed retrospectively.

Nine studies, with a total of 1,185 patients and 245 PF cases, met the inclusion criteria. Meta-analysis revealed that PF status was significantly associated with inferior survival at 1-5 years (pooled OR 0.40; 95 % CI 0.26-0.62; p < 0.0001). The increased risk of death was particularly evident in dedifferentiated CS (pooled HR 1.96; 95 % CI 1.46-2.63; p < 0.00001). Institutional data supported these findings, that PF was associated with worse overall survival (HR 3.90; 95 % CI 0.69-21.98; p = 0.12) and progression-free survival (HR 3.17; 95 % CI 0.58-17.36; p = 0.18), although significance was limited by sample size.

Pathological fractures entail a significantly adverse prognosis in chondrosarcoma, particularly in high-grade and dedifferentiated subtypes and within the first 5 years of follow-up. Our institutional data corroborates meta-analysis findings. These results underscore the importance of personalized surgical management and intensive outcome monitoring for CS patients presenting with PF.