Retrospective review of children with osteogenic sarcoma from 1990 to 2010 at a tertiary hospital in Johannesburg
Date
2018
Authors
Ngcana, Thandeka Vuyiswa Zamansundu
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Abstract
BACKGROUND
Survival rates of South African children with osteosarcoma (OS) are known to be poor but prognostic factors have not been elucidated in an African setting.
AIM AND SETTING
To determine the overall survival rate and prognostic factors in children with OS at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).
METHODS
A retrospective review was conducted of children with OS from 1990 to 2010. Descriptive statistics, Kaplan-Meier survival analysis and Cox logistic regression were performed.
RESULTS
55 files were available for analysis. The median symptom duration was 90 days. The median age was 12.1years. The majority had poor prognostic features: 47 (85%) had masses larger than 8cm diameter, all patients had high alkaline phosphatase and 46 (83.6%) had elevated lactate dehydrogenase (LDH). Histology included osteoblastic (37/55) and chondroblastic OS (9/55). Forty-three (78.2%) patients had low BMI at presentation. Forty-one patients were treated with ifosfamide, doxorubicin, methotrexate and cisplatinum and one patient was on a hybrid protocol. Thirteen (25%) did not receive chemotherapy and four patients declined surgery. The five-year survival rate of those treated with curative intent was 42%. Causes of death included progression of disease (22/42) and treatment complications (5/42). On univariate analysis site of primary tumour (p = 0.044), LDH (p = 0.011) and stage (p = 0.0001) impacted on survival, while on multivariate analysis confirmed only stage (p=0.0001) and unknown LDH level (p= 0.011) as significant.
CONCLUSION
Advanced disease at presentation, which is a modifiable factor, was common and impacted negatively on overall survival.
Description
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfilment of the requirements for the degree
of
Masters in Medicine (MMed).
Johannesburg, March 2018.
Keywords
Children