Review and analysis of the treatment of polycentric osteosarcoma in China

Objective To investigate the clinical and epidemiological characteristics of osteosarcoma in China and analyze the incidence and clinical treatment of osteosarcoma. Methods The clinical data of 1 593 patients with osteosarcoma in 7 bone cancer treatment centers from January 2000 to February 2017 were analyzed.We retrieved large samples of documents in the database, extracted the relevant data and compared the data with this study. SPSS 13 software was used for statistical analysis and each factor was tested by χ2. Results Of 1 593 patients, 984 were males and 609 were females. The ratio of male to female was 1.62∶1. The average age was 23.2 years (range from 3-80 years). The peak age of onset was 11-20 years (52.4%). There were 217 elderly patients (>40 years old). The tumors occurred in 1 524 limbs and 69 in axial bone. The most common sites of disease were distal femur 706 cases, proximal tibia 375 cases, distal humerus 117 cases and others 395 cases. There were 1 154 cases (71%) around the knee joint. The axial bone included 18 cases of spine, 49 cases of pelvis and 2 cases of rib. Preoperative biopsy was performed in 1 111 cases and incisional biopsy in 280 cases. Preoperative diagnosis could be made in 1 345 cases (84.4% of all patients, accounting for 96.7% of biopsy patients). There were 79 cases with metastasis at first visit, accounting for 5%. Preoperative chemotherapy was performed in 1 185 cases (74.4%). With the DIA preoperative chemotherapy 271 cases, DIA+MTX 251 cases, AP 149 cases. 220 cases of tumor cell necrosis rate was evaluated after operationaccording to the Huvos classification. There were 78 cases of grade I, 105 cases of II grade, 35 cases of III and 2 cases of grade IV. There were 1 299 cases undergoingpostoperative chemotherapy (81.5%), 1 306 patients undergoinglimb salvage surgery (82%). Thespecific operation with prosthetic replacement is the most common (911 cases, 69.8%). The postoperative chemotherapy included DIA+MTX regimen 471 cases, DIA regimen 266 cases and AP regimen 98 cases. Before and after the operation, 379 cases were treated with the same chemotherapy regimen and 666 cases were changed. A total of 18 large sample documents were retrieved in Chinese data base (5 684 cases).The sex ratio, age range, peak incidence and location of the disease were similar to those of this study. The average age was 1-2 years old younger.The percentage of lung metastases associated with initial visits washigher. The rate of preoperative and postoperative chemotherapy and limb salvage waslowand the rate of tumor necrosis wasbetter after chemotherapy. A total of 22 large sample literatures were searched in foreign database (12 850 cases). The ratio of men and women is 1.30∶1 and the proportion of women is higher than the domestic data. The average age was 1-2 years older. The ratio of the knee joint was lower. The percentage of lung metastases associated with initial visits washigher. The rate of preoperative and postoperative chemotherapy and limb salvage were similar to that of this study and the rate of tumor necrosis was better after chemotherapy. Conclusion The general situation of the incidence of osteosarcoma (sex, age, location of the disease) is not significantly different from the previous reports both at home and abroad. In the treatment, preoperative and postoperative chemotherapy rate and limb salvage surgery rate have improved significantly compared with the past.The chemotherapy program from the coexistence of various programs, gradually to the DIA+MTX and DIA program as the mainstream program. Key words: Osteosarcoma; Epidemiology; Antineoplastic protocols; Comparative study