(P 84) PROGNOSTIC IMPLICATIONS OF PATHOLOGICAL FRACTURES IN EXTREMITY OSTEOSARCOMA: A RETROSPECTIVE ANALYSIS OF SURVIVAL OUTCOMES AND LIMB-SALVAGE FEASIBILITY

Objective: BACKGROUND:
The management of extremity osteosarcoma with associated pathological fractures remains contentious, with ongoing debates about the appropriateness of amputation versus limb-salvage surgery.

Methods: METHODS:
This retrospective analysis utilized a prospectively maintained database to evaluate the impact of pathological fractures on survival outcomes and to explore the viability of limb-salvage surgery in these cases.

Results: From 2000 to 2018, 395 patients met the inclusion criteria, with 59 patients diagnosed with pathological fractures. Among these, only serum alkaline phosphatase levels were markedly elevated in patients with fractures compared to those without. Patients with fractures also underwent amputation at higher rates. In the fracture group, there were 7 cases (13.72%) of local recurrences and 26 deaths (51%), compared to 32 cases (9.22%) of local recurrences and 199 deaths (57.34%) in the non-fracture group; these differences were not statistically significant. The five-year overall survival rates were 44.2±8.4% for the fracture group and 55.1±5.8% for the control group, with no significant difference (p=0.181). Similarly, five-year local recurrence-free survival rates were 75.8±3.7% for the fracture group and 87.8±2.4% for the control group, also without significant difference (p=0.173).

Conclusion: Pathological fractures in patients with primary extremity osteosarcoma do not significantly alter prognostic outcomes concerning overall survival (OS) or disease-free survival (DFS). Moreover, these fractures do not increase the risk of local recurrences, suggesting that limb-salvage surgery could be a feasible option for these patients.