Effect of pathological fracture on the prognosis of patients with limb osteosarcoma: a Meta-analysis

Objective: To evaluate the effect of pathological fracture on the prognosis of patients with limb osteosarcoma.Methods: A computer-based online search was performed by using EMBASE, Cochrane Library, PubMed, CNKI (China National Knowledge Infrastructure), Wanfang database, VIP database and Chinese Biomedical Literature Database. Relevant studies on clinical outcome of limb osteosarcoma patients with pathological fracture vs without pathological fracture were collected and the quality of the studies were assessed using Newcastle-Ottawa Scale. The data of the studies were abstracted. Meta-analysis was performed using Stata 12.0 software. Results: Ten studies of 2 604 cases entered the Meta-analysis, including 356 cases of osteosarcoma with pathological fracture (study group) and 2 248 cases of osteosarcoma without pathological fracture (control group). This Meta-analysis revealed that the patients in the study group had poor three-year overall survival (OS) [odds ratio (OR) = 2.57, 95% confidence Interval (CI): 1.54-4.29; P = 0.000) and five-year OS (OR = 1.57, 95% CI: 1.05-2.34; P = 0.029) than those in the control group. Furthermore, there were significant differences in three-year event-free survival (EFS) (OR = 1.87, 95% CI: 1.21-2.87; P = 0.005) and five-year EFS (OR = 1.52, 95% CI: 1.16-1.99; P = 0.002) between the study group and control group. No significant difference was found in the rate of local recurrence between the two groups (P > 0.05), and there was also no significant difference in the rate of local recurrence between patients who were treated with amputation and limb salvage in pathological fracture subgroup (P > 0.05).Conclusion: This meta-analysis suggests that the prognosis of limb osteosarcoma patients with pathological fracture is more worse than that of the patients without pathological fracture. There is no higher risk in the rate of local recurrence after limb salvage in patients with pathological fracture. DOI:10.3781/j.issn.1000-7431.2015.33.786