Prognostic Factors for Recurrence

Time from diagnosis. In 564 patients who experienced a recurrence, patients whose disease recurred within 2 years of diagnosis had a worse prognosis than patients whose disease recurred after 2 years.[1] In another series of 431 patients, recurrences occurring less than 2 years from diagnosis were also associated with worse outcomes.[5]

Age at initial diagnosis. Older age at initial study enrollment was associated with a worse prognosis after recurrence.[5]

Presence of metastatic disease at diagnosis. The presence of metastatic disease at initial presentation was associated with a worse prognosis after recurrence.[5]

Tumor response to preoperative chemotherapy. Patients with a good histological response to initial preoperative chemotherapy had a better overall survival (OS) after recurrence than did patients with a poor initial response.[1]

Site of metastases. In two large series, the incidence of recurrence by site was as follows: lung only (65%–80%), bone only (8%–10%), local recurrence only (4%–7%), and combined relapse (10%–15%).[4,6] Abdominal metastases are rare but may occur as late as 4 years after diagnosis.[7] The Children's Oncology Group (COG) reported the outcomes of 431 young patients with recurrent osteosarcoma.[5][Level of evidence C3] Patients with recurrences in both lung and bone had worse outcomes than did patients with recurrences in lung only (P = .005).

Surgical resectability. Patients with recurrent osteosarcoma should be assessed for surgical resectability because they may sometimes be cured with aggressive surgical resection with or without chemotherapy.[8,6,9-12] Control of osteosarcoma after recurrence depends on complete surgical resection of all sites of clinically detectable metastatic disease. If surgical resection is not attempted or cannot be performed, progression and death are certain. The ability to achieve a complete resection of recurrent disease is the most important prognostic factor at first relapse, with a 5-year survival rate of 20% to 45% after complete resection of metastatic pulmonary tumors and a 20% survival rate after complete resection of metastases at other sites.[4,6,12,13]