International Orthopaedics

, Volume 43, Issue 7, pp 1741–1747 | Cite as

Survival analysis of elderly patients with osteosarcoma

  • Yoshinori ImuraEmail author
  • Satoshi Takenaka
  • Shigeki Kakunaga
  • Takaaki Nakai
  • Toru Wakamatsu
  • Hidetatsu Outani
  • Takaaki Tanaka
  • Hironari Tamiya
  • Kazuya Oshima
  • Kenichiro Hamada
  • Norifumi Naka
  • Nobuhito Araki
  • Ikuo Kudawara
  • Takafumi Ueda
  • Hideki Yoshikawa
Original Paper



Few studies have described the characteristics and prognostic factors of elderly patients with osteosarcoma. We retrospectively investigated clinico-pathological features and prognostic factors in osteosarcoma patients > 40 years old.


Patients with high-grade osteosarcoma > 40 years old who were treated at our institutions from 2000 to 2016 were recruited for this study. Information on patient, tumour, and treatment-related factors was collected and statistically analyzed. The median follow-up was 26.5 months (range, 5–139 months) for all patients.


Fifty patients (30 males and 20 females) were included. The median age at diagnosis was 59.5 years (range, 41–81 years). The primary lesions were found in the limbs in 32 patients, trunk in 12, and craniofacial bones in six. Primary and secondary osteosarcoma occurred in 41 and 9 patients, respectively. Eight patients exhibited initial distant metastasis. Definitive surgery and chemotherapy were performed in 39 patients each. The rate of good responders after neoadjuvant chemotherapy was 38%. The five year overall survival (OS) rates for all patients and those without distant metastasis at diagnosis were 44.5% and 51.1%, respectively. Multivariate analysis showed that definitive surgery was the only significant prognostic factor in non-metastatic patients. The five year OS and disease-free survival (DFS) rates for non-metastatic patients who received definitive surgery were 64.3% and 60%, respectively. Among these patients, neoadjuvant and/or adjuvant chemotherapy significantly improved both OS and DFS.


Complete surgical resection and intensive chemotherapy should be performed for osteosarcoma patients > 40 years old despite distinct clinicopathological characteristics from those of younger patients.


Osteosarcoma Elderly patients Distant metastasis Definitive surgery Neoadjuvant and/or adjuvant chemotherapy 



This work was supported by JSPS KAKENHI Grant Number JP16H05448 and Grant of Japan Orthopaedics and Traumatology Research Foundation, Inc.372. We thank Enago for providing high-quality editing service.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Yoshinori Imura
    • 1
    Email author
  • Satoshi Takenaka
    • 2
  • Shigeki Kakunaga
    • 3
  • Takaaki Nakai
    • 4
  • Toru Wakamatsu
    • 1
  • Hidetatsu Outani
    • 2
  • Takaaki Tanaka
    • 1
  • Hironari Tamiya
    • 1
  • Kazuya Oshima
    • 5
  • Kenichiro Hamada
    • 2
  • Norifumi Naka
    • 1
  • Nobuhito Araki
    • 6
  • Ikuo Kudawara
    • 3
  • Takafumi Ueda
    • 3
  • Hideki Yoshikawa
    • 2
  1. 1.Musculoskeletal Oncology ServiceOsaka International Cancer InstituteOsakaJapan
  2. 2.Department of Orthopedic SurgeryOsaka University Graduate School of MedicineOsakaJapan
  3. 3.Department of Orthopedic SurgeryOsaka National HospitalOsakaJapan
  4. 4.Department of Orthopedic SurgeryKawachi General HospitalOsakaJapan
  5. 5.Department of Orthopedic SurgeryBell-land General HospitalSakaiJapan
  6. 6.Department of Orthopedic SurgeryAshiya Municipal HospitalAshiyaJapan

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