Background: Postoperative infections remain a critical concern in the management of osteosarcoma, particularly after limb salvage surgery. While infections are often perceived as detrimental, emerging evidence suggests that under certain circumstances, localized infections may improve survival outcomes. This study evaluated the relationship between postoperative infection and survival in Japanese patients with osteosarcoma.
Methods: We retrospectively reviewed the medical records of patients diagnosed with osteosarcoma who underwent surgery between April 1990 and October 2021 at nine institutions. Patients with trunk or pelvic lesions, distant metastases at initial diagnosis, age over 60, or infections occurring more than 1 year postoperatively were excluded.
Results: Among 466 eligible patients, 34 (7.3%) developed postoperative infections. The 5-year overall survival rate was 84.4% in infected patients and 82.9% in non-infected patients, with no significant difference (p = 0.778). The proximal tibia was more susceptible to infection than other sites, with an odds ratio of 2.621 (p = 0.008), and larger tumors were more likely to develop infection (odds ratio, 1.093; p = 0.009).
Conclusions: Postoperative infection did not improve survival in patients with osteosarcoma. Tumors in the proximal tibia and those with larger maximum diameters were more susceptible to infection.
Keywords: osteosarcoma; postoperative infection; survival.
© 2026 Wiley Periodicals LLC.