International Orthopaedics

, Volume 43, Issue 8, pp 1983–1991 | Cite as

Survival analysis of patients with metastatic osteosarcoma: a Surveillance, Epidemiology, and End Results population-based study

  • Kehan Song
  • Jian Song
  • Kaiyuan Lin
  • Feiyan Chen
  • Xiaosheng Ma
  • Jianyuan JiangEmail author
  • Feng LiEmail author
Original Paper



The present study is aimed at investigating whether (1) primary tumour surgery confers an improved survival on patients with metastatic osteosarcoma and (2) primary tumour surgery influences survival of patients with metastatic osteosarcoma differently according to primary tumour site.


We retrospectively identified 517 patients with high-grade, metastatic osteosarcoma in the Surveillance, Epidemiology, and End Results (SEER) database between 1994 and 2013. The effect of primary tumour surgery on survival was assessed using Kaplan-Meier analyses, log-rank tests, and multivariate Cox proportional hazard regression modeling.


Of those 517 patients with metastatic osteosarcoma in the cohort, 351 patients (68%) underwent primary surgery, and 166 patients (32%) did not undergo surgery. Primary tumour surgery was associated with increased overall survival (hazard ratio (HR) = 0.457, 95% CI 0.354–0.590, p < 0.001) and cancer-specific survival (HR = 0.422, 95% CI 0.325–0.550, p < 0.001). When we focused on different primary tumour sites, receipt of primary tumour surgery significantly prolonged the survival of patients with extremity osteosarcoma (p < 0.05 for overall and cancer-specific survival). However, for patients with pelvis/spine osteosarcoma, both univariate and multivariate analyses indicated that primary tumour surgery might not be associated with improved survival (p > 0.05 for overall and cancer-specific survival).


Our study is the first population-based analysis to provide evidence of a favourable prognostic impact of primary tumour surgery on metastatic extremity osteosarcoma patients but not metastatic axial (pelvis/spine) osteosarcoma patients. Moreover, we found that surgery type (resection of the primary tumor without amputation vs. amputation) did not influence survival in patients with metastatic osteosarcoma.


Osteosarcoma Metastatic Surgery Survival 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Because we obtain data from the SEER database with open access, we did not need to acquire patient consent or an ethical review committee statement, but we were required to sign a Data Use Agreement for the SEER 1973–2014 Research Data File to gain access to the SEER database.

Supplementary material

264_2019_4348_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 20 kb)


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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  1. 1.Department of Orthopedics, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
  2. 2.Department of Orthopaedics, Huashan HospitalFudan UniversityShanghaiChina
  3. 3.Department of Orthopedic SurgeryThe First Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina

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