Post operative infection and increased survival in osteosarcoma patients: are they associated?

Ann Surg Oncol. 2007 Oct;14(10):2887-95. doi: 10.1245/s10434-007-9483-8. Epub 2007 Jul 26.


Background: Despite neo-adjuvant chemotherapy osteosarcomas having significant mortality, recent studies have shown survival advantages following infections for some tumour types. This study investigates the effect of post-operative infection in patients treated for osteosarcoma using endoprosthetic replacement and neo-adjuvant chemotherapy.

Material and methods: A consecutive series of 547 patients underwent surgery between 1981 and 2001 for osteosarcoma. Patients were excluded from the study if over 60 years old at diagnosis (n = 14) as they would not routinely receive chemotherapy. Studies showed that 70% of deep infections occur within one year from reconstruction. Therefore landmark analysis was performed; all patients infected after 12 months of reconstruction were excluded (15 patients, 2.7%) and those who died within 12 months from diagnosis due to metastases were excluded (105 patients, 19.2%), leaving 412 patients. Any survival advantage of early infection was analysed by Kaplan-Meier survival analysis from this landmark point.

Results: Overall population survival was 65% at 10 years after landmarking. There were 41 patients (10%) who developed an infection within one year of implantation. These patients had significantly better survival (p = 0.017). The 10-year survival for patients with osteosarcoma with infection was 84.5% compared to 62.3% in the non-infected group after landmarking. There was no significant difference in the percentage post-chemotherapy specimen necrosis between the two groups (p = 0.36). Infection was an independent prognostic factor on cox regression analysis.

Conclusions: There was evidence for increased survival after deep post-operative infection in osteosarcoma patients, in keeping with other research. The authors feel this warrants further investigation.

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bone Neoplasms / drug therapy
  • Bone Neoplasms / mortality*
  • Bone Neoplasms / pathology
  • Bone Neoplasms / surgery*
  • Combined Modality Therapy
  • Disease-Free Survival
  • Extremities / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Kaplan-Meier Estimate
  • Limb Salvage
  • Male
  • Middle Aged
  • Neoadjuvant Therapy*
  • Neoplasm Staging
  • Osteosarcoma / drug therapy
  • Osteosarcoma / mortality*
  • Osteosarcoma / pathology
  • Osteosarcoma / surgery*
  • Prognosis
  • Proportional Hazards Models
  • Prosthesis Implantation*
  • Prosthesis-Related Infections / mortality*
  • Retrospective Studies
  • Staphylococcal Infections / mortality*
  • Streptococcal Infections / mortality*
  • Surgical Wound Infection / mortality*