Preface- When I write this article, I took it seriously and felt stressed. I deem it as predicting a patient's future and his/her life and death. We construct our prediction biostatistically based on patient data accumulated over a decade. So, everything is just the statistic figure, and that doesn't mean absolute result! If you see the data later representing a relatively bad situation, please do not lose confidence. Instead, you should actively cooperate more with the treatment! We sometimes see many miracles that happen after treatment!
First, let's take a look at the 'Five-year survival rate'. The definition from Wikipedia states that " Five-year absolute survival rates describe the percentage of patients that are alive five years after their disease is diagnosed." Simply put, it's the proportion of patients who survive in the fifth year after being diagnosed with cancer. Some might ask: 'what about the time after five years?' The answer is: it will vary with each tumor. In osteosarcoma, there is generally a considerable chance of being cured if the patient has no local recurrence or metastasis that occurs five years after diagnosed, supposing that he/she can complete the chemotherapy and be regularly followed up by a physician.
More than 20 years ago, the prognosis for osteosarcoma was relatively poor, and it was deemed incurable. Because of advances in chemotherapy drugs, diagnostic instruments, and surgical techniques, the average five-year survival rate is generally about 50 to 80 percent. According to our study in 2014 at our Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, the average five-year survival rate for patients treated at our center is as high as 77%, which is at the top-tier globe wide.
Many important factors affect prognosis, including age, tumor size, tumor location, pathological fractures, metastasis, tumor necrosis rate after chemotherapy, etc. One of the most critical factors, however, is whether a metastasis occurs. According to the study result published in the journal Annals of Surgery Oncology in 2015 by Dr. JY Hong at the Department of Pediatrics in our Osteosarcoma Treatment Center, without lung metastasis, the average five-year survival rate for our patients today can even be as high as 90.4%! It is quite an inspiring result! However, if metastasis occurred, the average five-year survival rate would fall to 30 percent.
Compared to the results before 2004, the overall tumor necrosis rate after chemotherapy increased by 30%, and the overall patient survival rate increased by 20%. Considering such progress, we shall give our most tremendous respect to our pediatric oncologists- Dr. JY Hong and Dr. SR Yan, and to the hematology oncologist- Dr. JC Yan and Dr. DC Zhao. The comprehensive information regarding the overall five-year survival rate and the influence of various factors on five-year survival rate are shown below in the citation of the research by Dr. JY Hong:
Overall, with the teamwork in our Therapeutical and Research Center of Musculoskeletal Tumor, Taipei Veterans General Hospital, the treatment of osteosarcoma has achieved remarkable results. We compare our research results with those published results from well-known osteosarcoma treatment centers in nearby Asian countries and the world, as the chart below. We understand that the comparison will have its limitations, including different times of studies, different choice of patients, etc., and it's used as a comparative reference.
Reference:
1. Long-term results of combined therapy for primary osteosarcoma in extremities of 189 cases. Zhonghua Wai Ke Za Zhi. 2005 Dec 15;43(24):1576-9.
2. Multiinstitutional phase II study of neoadjuvant chemotherapy for osteosarcoma (NECO study) in Japan: NECO-93J and NECO-95J. Journal of Orthopaedic Science : 14(4), 397–404.
3. Long-Term Survivals of Stage IIB Osteosarcoma: A 20-Year Experience in a Single Institution. Clinics in Orthopedic Surgery, 3(1), 48.
4. Osteogenic sarcoma in children and young adults. Ann Acad Med Singapore. 2014 Jun;43(6):305-13.
5. Experience of Pediatric Osteosarcoma of the Extremity at a Single Institution in Taiwan: Prognostic Factors and Impact on Survival. Ann Surg Oncol. 2014;22(4):1080-1087.
Reference:
1. Osteosarcoma, Chondrosarcoma, and Ewing's Sarcoma. Clinical Orthopedics and Related Research, 459, 40–47.
2. Frontline treatment of localized osteosarcoma without methotrexate. Cancer, 117(12), 2770–2778.
3. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. Journal of Clinical Oncology 20(3), 776–790.
4. Experience of Pediatric Osteosarcoma of the Extremity at a Single Institution in Taiwan: Prognostic Factors and Impact on Survival. Ann Surg Oncol. 2014;22(4):1080-1087.
note1 :
Experience of Pediatric Osteosarcoma of the Extremity at a Single Institution in Taiwan: Prognostic Factors and Impact on Survival. Ann Surg Oncol. 2014;22(4):1080-1087.