The effects of unplanned surgical intervention on the long-term treatment outcomes of patients with osteosarcoma

Primary bone tumors are relatively rare but their diagnosis and treatment is difficult and connected with a high risk of complications. The most common primary bone sarcoma is the osteosarcoma, which in Poland it constitutes about 1% of all bone neoplasms and less than 1% of all malignancies. It is confirmed that the inappropriately performed diagnosis and treatment in soft sarcoma negatively influences patients survival but data about bone tumor are limited. The goal of this study is a retrospective evaluation of the influence of unplanned surgical excision of osteosarcoma on long treatment result. We have analyzed 299 patients with osteosarcoma treated in the years 1998-2016 at the Maria Skłodowska Curie Institute – Oncology Centre in Warsaw. The median observation period was 60 months. Patients were divided into groups: in first group patients were referred to our center with suspicion of osteosarcoma and the whole process of diagnosis and treatment was made there, in the second group biopsy was made outside referral center, and patients were sent to our center after histopathology result and in the third group patients were diagnosed and treated outside of a referral unit in an unplanned manner. The effects of treatment were significantly better if the biopsy and treatment were performed in the referral unit or biopsy was made in a local clinic and then patients were treated in referred center – the 5 year OS rate was 49%. Patients who were admitted to the referral center after biopsy and improper treatment in regional hospital (“whoops operations”) had a 5 year overall survival rate of 27%; p=0.011. During initial diagnostics, patients with suspicion of osteosarcoma on medical imaging, should be sent to referral center to obtain the correct diagnosis and treatment, which gives them the best chances for long survival and avoiding disability.