PURPOSE The objective of this study was to investigate potential correlations between pathologic fractures (PFs) and prognosis of patients with primary central high-grade osteosarcoma of the extremities. METHODS We retrospectively analyzed 2,847 patients registered in the Consecutive Cooperative Osteosarcoma Study Group database with primary central high-grade osteosarcoma of the extremities, treated between 1980 and 2010. Intended treatment included pre- and postoperative chemotherapy and surgery. Univariable and multivariable survival analyses were performed for all patients and then differentiated for adult and pediatric (≤ 18 years at time of diagnosis) patients. RESULTS A total of 2,193 patients were ≤ 18 years of age; 11.3% of all patients had PFs. In the overall cohort, presence of PF correlated significantly with tumor site, histologic subtype, relative tumor size, and primary metastases, but not with body mass index or local surgical remission. In univariable analysis, 5-year overall survival (OAS) of patients with and without PF was 63% versus 71%, respectively (P = .007), and 5-year event-free survival (EFS) was 51% versus 58% (P = .026). In pediatric patients, OAS and EFS did not differ significantly between patients with and without PF. In adults, 5-year OAS in patients with and without PF was 46% versus 69% (P < .001), and 5-year EFS was 36% versus 56% (P < .001). In multivariable analysis, PF was not a statistically significant factor for OAS or EFS in the total cohort or in pediatric patients. In adult patients, PF remained an independent prognostic factor for OAS (P = .013; hazard ratio [HR], 1.893). It was not a significant prognostic factor for EFS (P = .263; HR, 1.312). CONCLUSION In this largest study to date with extremity osteosarcomas, we observed the occurrence of PF to correlate with inferior OAS expectancies in adult but not in pediatric patients.

中文翻译：

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四肢高级别骨肉瘤的病理性骨折和预后：对 2,847 名连续合作骨肉瘤研究组 (COSS) 患者的分析

目的 本研究的目的是调查病理性骨折 (PFs) 与四肢原发性中央高级别骨肉瘤患者预后之间的潜在相关性。方法 我们回顾性分析了连续合作骨肉瘤研究组数据库中登记的 1980 年至 2010 年间接受治疗的四肢原发性中央高级别骨肉瘤的 2,847 例患者。预期治疗包括术前和术后化疗和手术。对所有患者进行单变量和多变量生存分析，然后区分成人和儿童（诊断时≤ 18 岁）患者。结果 共有 2,193 名患者≤ 18 岁；11.3% 的患者患有 PF。在整个队列中，PF 的存在与肿瘤部位显着相关，组织学亚型、相对肿瘤大小和原发转移，但与体重指数或局部手术缓解无关。在单变量分析中，有和无 PF 患者的 5 年总生存率 (OAS) 分别为 63% 和 71% (P = .007)，5 年无事件生存率 (EFS) 分别为 51% 和 58% (P = .026)。在儿科患者中，患有和不患有 PF 的患者之间的 OAS 和 EFS 没有显着差异。在成人中，PF 患者和非 PF 患者的 5 年 OAS 分别为 46% 和 69% (P < .001)，5 年 EFS 分别为 36% 和 56% (P < .001)。在多变量分析中，PF 不是整个队列或儿科患者中 OAS 或 EFS 的统计显着因素。在成年患者中，PF 仍然是 OAS 的独立预后因素（P = .013；风险比 [HR]，1.893）。它不是 EFS 的重要预后因素（P = .263；HR，1.312）。结论 在这项迄今为止最大的四肢骨肉瘤研究中，我们观察到 PF 的发生与成人的低 OAS 预期相关，但与儿科患者无关。