Pathologic Fracture Predicts for Poor Prognosis in Osteosarcoma for Recurrence and Amputation Based on X-ray

Objective: The significance of pathologic fracture and prognosis for osteosarcoma is still controversial.The aim was to provide a Meta-analysis for pathologic fracture and prognostic features of osteosarcoma patients.Methods: A detailed search was made in MEDLINE, EMBASE and the Web of Knowledge for relevant original articles published in English; methodological quality of the included studies was also assessed. Two reviewers extracted data independently. Studies were pooled and odds ratio(ORs) with corresponding confidence intervals(CIs) were calculated. Results: Pool analysis of 1502 patients from 5 eligible studies was performed. Combined OR of pathologic fracture indicated that pathologic fracture was associated with local recurrence(n=1 018 in 4 studies; OR=1.83; 95% CI:1.06~3.15; P=0.03) and the limb salvage(n=1 502 in 5 studies; OR=1.84; 95%CI:1.25~2.72; P=0.002) but not with adequate margin(n=1 501 in 5 studies; OR=0.74; 95% CI:0.39~1.40;P=0.35) or histological response to neoadjuvant chemotherapy(n=1 420 in 4 studies; OR=0.41; 95% CI:0.98~2.05; P=0.07). Conclusion: The results of this Meta-analysis indicate that a higher risk of local recurrence and amputation were achieved in osteosarcoma patients with pathological fracture than those without pathological fracture. The pathologic fracture is a predictor of poor prognosis in osteosarcoma.