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Chondrosarcoma of the Pelvis Prognostic Factors and Survival Analysis at 10-20 Years

Chondrosarcoma of the Pelvis Prognostic Factors and Survival Analysis at 10-20 Years. Matthew J. Seidel, MD Patrick P. Lin, MD Valerae O. Lewis, MD Christopher P.Cannon, MD Alan W. Yasko, MD. Literature. Goal of Study.

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Chondrosarcoma of the Pelvis Prognostic Factors and Survival Analysis at 10-20 Years

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  1. Chondrosarcoma of the PelvisPrognostic Factors and Survival Analysis at 10-20 Years Matthew J. Seidel, MD Patrick P. Lin, MD Valerae O. Lewis, MD Christopher P.Cannon, MD Alan W. Yasko, MD

  2. Literature

  3. Goal of Study • Define long-term oncologic outcome and prognostic factors for chondrosarcoma arising in the pelvic bones

  4. Study Design • Pelvic chondrosarcoma • Surgically treated with curative intent • Minimum 5 year f/u for living patients • 5 year potential f/u for deceased patients • Exclusion: • Sacral epicenter • Recurrent presentation • Metastatic presentation • Prior resection/surgery (other than biopsy)

  5. Data Collection • Retrospective medical record review including operative, pathology, and radiology reports • Demographics • Tumor grade, size, location, physical characteristics • Surgical type and margins • Timing and location of local recurrence and metastasis • Long-term data from clinical follow-up, phone call, or letter

  6. Statistics • Kaplan-Meier survival • Disease-specific survival • Local recurrence-free survival • Distant relapse-free survival • Log rank (determine difference between KM curves) • Chi-square or Fisher’s exact test

  7. 101 Patients • Collection period: 1948-2000 • Follow-up: 5 to 45 years • Overall median 6 year follow-up • Living patients: median 13 year follow-up • 31 female, 70 male

  8. Overall Survival • Status At Last Follow-up • 41 NED • 1 AWD • 45 DOD • 13 DOC • 1 DUC

  9. Grade • 34 Low • 24 Intermediate • 27 High • 16 Dedifferentiated

  10. Epicenter • Ilium: 57 • Pubis: 24 • Acetabulum: 10 • Ischium: 10

  11. Tumor Characteristics • Mean Size: 18.5 cm • Range 3 to 25 cm • Extra-osseous extension in 91 (90%)

  12. Surgical • Surgery Type • Amputation: 37 • Limb salvage: 64 • Surgical Margins • Negative: 56 • Positive: 42 • Not Specified: 3

  13. Disease-Specific Survival

  14. Disease-Specific Survival

  15. DSS: Prognostic Variables

  16. Effect of LR On DSS • Significant decrease in survival for patients with LR • P=.007

  17. Effect of LR On DSSLow Grade • Significant survival difference • P=.003

  18. Effect of LR On DSSIntermediate Grade • Marginal significance • P=.08

  19. Effect of LR On DSSHigh Grade • Not Significant • P=0.42

  20. Results – Local Recurrence • 35 Local Recurrences • Mean time 29 months • Range 3 to 120 months • 91% (32/35) occurred within five years • 3 Local Recurrence after five years • 84 months (low-grade) • 108 months (intermediate-grade) • 120 months (low-grade)

  21. Results – Local Recurrence • 68% of LR (23/34) associated with positive resection margins

  22. Local Recurrence-Free Survival

  23. LR – Prognostic Variables

  24. Results - Metastasis • 28 Metastasis • Mean time 22 months • Range 1-114 months • Location • Lung most common (27) • Other locations: liver (4), brain (2), spine (2), kidney (1), heart (1), pericardium (1), humerus (1), lymph node (1), scalp (1)

  25. Results - Metastasis • 93% (26/28) metastasis occurred in first four years • Two metastasis occurred after four years • 74 months (low-grade; LR at 23, 36, 41 months) • 114 months (intermediate-grade; LR at 108 months)

  26. Results - Metastasis • 26/28 (93%) DOD at last follow-up • Median time 9 months • 2/28 (7%) • DOC (1): NED 5 years after wedge resection at 24 mo • AWD(1): alive 4 years, wedge resection pending • Metastasis has a significant negative effect on DSS (p<.0001)

  27. Distant Relapse-Free Survival

  28. DR-Prognostic Variables

  29. Study Limitations • Diminishing number of patients at 20 years • 39% >10 yr f/u • 17% >20 yr f/u • Changes in mode and quality of radiographic imaging over study period • Vagaries of histological grading • Limited long-term radiographic imaging

  30. Conclusions • Long term follow-up data show LR or metastasis can occur beyond five years • No first LR or metastasis was seen after 10 years

  31. Conclusions • Local Recurrence has a significant negative effect on long term survival • Most pronounced for low and intermediate grade tumors. • Metastasis overwhelmingly resulted in death

  32. Conclusions • Significant prognostic factors at late follow-up are unchanged from short-term follow-up data • Disease-specific survival • Local recurrence-free survival • Distant relapse-free survival

  33. Conclusions • Evidence-based post-operative surveillance strategy should include at least 10 year follow-up after initial resection

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