A meta-analysis comparing efficiency of limb-salvage surgery vs amputation on patients with osteosarcoma treated with neoadjuvant chemotherapy

Abstract

Osteogenic sarcoma is the central malignant bone neoplasm affecting the bones of arms and legs and rarely the soft tissues outside the bones. Historically, amputation was the chief surgical technique; currently, the popular standard is limb salvage surgery (LSS), although both procedures' effect on 5-year-event survival, 5-year disease-free survival rates (DFS) and the local recurrence is uncertain. Therefore, this meta-study aimed to establish the relationship between the effect of LSS and amputation in subjects with osteogenic carcinoma. A systematic survey till January 2021 to know the effect of LLS vs amputation with subjects treated with neoadjuvant chemotherapy was conducted. Clinical studies were identified with 9760 subjects with osteosarcoma of the extremities at the beginning of the trial; 7095 of them were managed with limb salvage surgery and 2611 with amputation. This study tried to compare the effects of LSS vs amputation in subjects with osteogenic sarcoma in the extremities. The dichotomous method in statistical analysis was used as a tool for establishing odds ratio (OR) at a confidence interval of 95% (CI) to assess the efficiency of LSS and amputees with osteosarcoma of the extremities with a fixed or random-effect model. Although patients with osteosarcoma of the extremities managed with LSS were significantly related to a higher local recurrence rate than those treated with amputation, they were also associated with higher 5-year overall survival (OS) than amputation. Patients showed no significant difference in a 5-year DFS rate between LSS vs amputation. The subjects who have undergone LSS for osteosarcoma of the extremities may have a higher risk of local recurrence than amputees. However, LSS may increase 5-year OS compared to amputees. These results depict that local recurrence of osteosarcoma does not influence survival rate. However, more studies are needed to validate this finding.

Keywords: 5-year disease-free survival rate; 5-year overall survival; amputation; limb salvage surgery; osteosarcoma.