Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis

J Clin Oncol. 2013 Jun 20;31(18):2303-12. doi: 10.1200/JCO.2012.43.8598. Epub 2013 May 13.

Abstract

Purpose: The LIVESTRONG Young Adult Alliance has conducted a meta-analysis of individual patient data from prospective neoadjuvant chemotherapy osteosarcoma studies and registries to examine the relationships of sex, age, and toxicity on survival.

Patients and methods: Suitable data sets were identified by a survey of published data reported in PubMed. The final pooled data set comprised 4,838 patients from five international cooperative groups.

Results: After accounting for important variables known at study entry such as tumor location and histology, females experienced higher overall survival rates than males (P = .005) and children fared better than adolescents and adults (P = .002). Multivariate landmark analysis following surgery indicated that a higher rate of chemotherapy-induced tumor necrosis was associated with longer survival (P < .001), as was female sex (P = .004) and the incidence of grade 3 or 4 mucositis (P = .03). Age group was not statistically significant in this landmark analysis (P = .12). Females reported higher rates of grade 3 or 4 thrombocytopenia relative to males (P < .001). Children reported the highest rates of grade 3 or 4 neutropenia (P < .001) and thrombocytopenia (P < .001). The achievement of good tumor necrosis was higher for females than for males (P = .002) and for children than for adults (P < .001).

Conclusion: These results suggest fundamental differences in the way chemotherapy is handled by females compared with males and by children compared with older populations. These differences may influence survival in a disease in which chemotherapy is critical to overall outcomes.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Bone Neoplasms / drug therapy*
  • Bone Neoplasms / surgery
  • Chemotherapy, Adjuvant / adverse effects
  • Child
  • Combined Modality Therapy
  • Humans
  • Kaplan-Meier Estimate
  • Multivariate Analysis
  • Neoadjuvant Therapy / adverse effects
  • Neutropenia / chemically induced
  • Osteosarcoma / drug therapy*
  • Osteosarcoma / surgery
  • Outcome Assessment, Health Care / statistics & numerical data
  • Prospective Studies
  • Regression Analysis
  • Sex Factors
  • Thrombocytopenia / chemically induced
  • Young Adult