Prognostic Analysis of Endoprosthetic Reconstruction Versus Biological Reconstruction in the Treatment of Extremity Osteosarcoma

TL;DR

This study compares endoprosthetic and biological reconstruction in treating osteosarcoma, finding that endoprosthetic methods offer better survival and lower recurrence rates.

Contribution

The study provides evidence-based guidance on surgical strategies for extremity osteosarcoma treatment.

Findings

Endoprosthetic reconstruction showed higher 5-year survival and lower local recurrence rates compared to biological reconstruction.

Biological reconstruction was identified as an independent risk factor for local recurrence.

Patient age and tumor location should influence reconstruction method selection.

Abstract

Osteosarcoma is a rare primary malignant bone tumor. Biological reconstruction techniques for bone defects following tumor resection remain less frequently adopted globally compared to endoprosthetic approaches. This retrospective study compared oncologic outcomes between endoprosthetic and biological reconstruction in 133 extremity osteosarcoma patients. Results indicate that endoprosthetic reconstruction was associated with superior local control and survival metrics, providing evidence-based guidance for surgical strategy selection in clinical practice.

Objective: To compare the clinical prognosis of metal endoprosthetic reconstruction versus biological reconstruction in the treatment of limb osteosarcoma and to analyze associated prognostic factors. Methods: From October 2014 to October 2021, a retrospective study was carried out of patients with high-grade extremity osteosarcoma. Patients were categorized into two groups based on the type of reconstruction: endoprosthetic reconstruction and biological reconstruction. Demographic data and prognosis were systematically compared between the two groups. Furthermore, a Cox proportional hazards model was employed to evaluate the risk factors associated with recurrence and survival outcomes. Results: A total of 133 patients were enrolled in the study, comprising 88 patients in the endoprosthetic reconstruction group and 45 patients in the biological reconstruction group. The 5-year overall survival (OS) and disease-free survival (DFS) rates for the endoprosthetic reconstruction group were 76.2% and 70.5%, respectively, which were higher than those observed in the biological reconstruction group (64.3% and 60%). Additionally, the local recurrence rate was significantly higher in the biological reconstruction group compared to the endoprosthetic reconstruction group (17.8% vs. 2.3%, p = 0.004). Cox regression analysis revealed that pathological fracture (p = 0.034) and the biological reconstruction (p = 0.007) were independent risk factors for local recurrence. Conclusions: Endoprosthetic reconstruction may be preferable for patients requiring early functional recovery or presenting with pathological fractures. Biological reconstruction may be considered for younger patients with diaphyseal defects and demanding long-term functional requirements, albeit with elevated local recurrence risk. Individualized decision-making incorporating tumor location, patient age, and functional goals is essential.

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