Evaluation of prognostic factors affecting survival in chondrosarcoma treatment and comparison with literature
Department of Orthopedics and Traumatology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
Keywords: Chondrosarcoma, prognostic factors, survival, tumor.
Objectives: The aim of this study was to identify the demographic characteristics of chondrosarcoma (CS) and prognostic factors affecting survival.
Patients and methods: A total of 87 patients (45 males, 42 females; median age: 51.3 years; range, 19 to 77 years) with CS treated in our clinic between January 2007 and June 2020 were retrospectively analyzed. Demographic characteristics, whether it was primary/secondary, tumor location, histopathological features, tumor grade and stage, clinical follow-up period, surgical treatment methods, use of radiotherapy and chemotherapy, and the presence of local recurrence and metastasis in the postoperative period were recorded. The relationship of these factors with prognosis was analyzed and survival rates were compared.
Results: Histological subtype, tumor grade, pathological stage and presence of metastasis were defined as independent predictors in both overall survival and disease-free survival analysis of CS. Overall and disease-free five-year and 10-year survival rates were found to be the highest in the clear cell chondrosarcoma group. While mortality increased in the first five years in the patient groups with histological Grade 2 and 3, all groups were followed in a balanced manner over time. The mortality rate in the group with metastatic disease (M2) was approximately four times higher than the other groups at 10-year follow-up. According to the surgical margins, we found that the five-year survival rates of the R1 (marginal resection) and R2 (residual tumor) groups were similar, with the highest rate being in the R0 (wide resection) group with 78.3%. In multivariate analysis, only grade and stage had a significant association with disease-specific survival. Surgical resection combined with adjuvant radiotherapy was found to increase survival in both overall and disease-free survival of patients with dedifferentiated chondrosarcoma compared to other treatments.
Conclusion: Histological subtype, grade, stage and presence of metastasis were the independent prognostic factors for survival in CS. However, marginal resection was a risk factor for local recurrence (LR), but there was no significant difference in overall survival in patients with or without LR. Although it is not significant, radiotherapy could increase survival in dedifferentiated CS variants.
Citation: Coşkun HS, Erdoğan F, Büyükceran İ, Dabak N. Evaluation of prognostic factors affecting survival in chondrosarcoma treatment and comparison with literature. Jt Dis Relat Surg 2022;33(2):440-448.
This study was found ethically appropriate by the Ondokuz Mayıs University Clinical Research Ethics Committee (date: 17.07.2020, no: 2020/413). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Idea/concept: N.D., H.S.C.; Design: N.D., H.S.C., F.E.; Control/supervision: N.D.; Data collection and/or processing: F.E., H.S.C.; Analysis and/or interpretation: F.E., H.S.C., İ.B.; Literature review: İ.B., F.E.; Writing the article: F.E., H.S.C.; Critical review: N.D.; References and fundings: İ.B.; Materials: İ.B., F.E.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The authors thank them for the support of our department secretary and our ethics committee, who assisted in collecting data from the hospital database and official authorization for the study.