Proffered Papers— Surgical Treatment of Sarcomas

CHONDROSARCOMA OF BONE: ANALYSIS OF FACTORS RELATED TO PROGNOSIS IN 108 CASES WITH A MINIMUM OF TWO YEARS FOLLOW-UP:

Rizzo M, Grt MA, Harrelson JM, Scully SP (Duke University Medical Center, Durham NC, 27710)

INTRODUCTION: Chondrosarcoma is unresponsive to existing adjuvant therapies and is primarily a surgical disease. There is an established relationship between the histologic grade of these tumors and prognosis. The purpose of this study was to review our institution’s experience with chondrosarcoma and assess factors related to prognosis and outcome.

METHODS: The medical records of 108 patients were retrospectively reviewed. Data was evaluated with respect to patient demographics, tumor location, histologic grade, tumor size, surgical margins, metastases and recurrence. The tumors were sub-classified based on histologic grade with grade 1 lesions defined as low-grade and grade 2 and 3 lesions (as well as dedifferentiated lesions) defined as high-grade. All patients were followed for a minimum of two years. Statistical analysis was performed using univariate, multivariate, and Kaplan-Meier survival analysis.

RESULTS: There were 68 males and 40 females with a mean age at presentation of 53 years (range 26-70 years). Clinical follow-up averaged 97 months (range:3-314). The most common tumor locations included the femur (46), pelvis (22) and humerus (10). There were 31 low-grade and 77 high-grade chondrosarcomas. One hundred and one patients underwent surgical resection. Wide margins were achieved in 78 patients, 11 underwent marginal resection and 12 tumor resections had positive margins (intralesional). Seventy-two patients remained alive at the time of this study with no evidence of disease, 23 have died of disease, 6 died without disease and 7 remain alive with recurrent disease. The high-grade tumors had a significantly increased rate of death due to disease (P<0.01), development of metastases (P<0.01), and local recurrence (P<0.01). There was a significant relationship between local recurrence and positive margins (P<0.03), and between metastases and positive margins (P<0.03). Patient demographics, tumor location and size did not correlate significantly with outcome.

CONCLUSIONS: This study supports previous findings that tumor grade in chondrosarcoma has prognostic significance, and that adequate surgical margins are essential to maximize survival. As chondrosarcoma does not respond to standard chemotherapy or radiation protocols, our findings emphasize the need for molecular markers and novel biologic adjuvant therapies.