Prognosis of limb-salvage treatment of osteosarcoma in adolescent patients: a meta-analysis

To evaluate the effectiveness of limb-salvage treatment for osteosarcoma in adolescent patients, a comprehensive search on PubMed, Embase and Cochrane Library was conducted. Studies with a clear diagnosis of osteosarcoma were included and duplicate publications, studies without full text or incomplete information, those with an inability to extract data, divergent definitions of exposure, animal experiments, reviews, and systematic reviews were excluded. The data were analyzed using STATA 15.1. The findings of the present study revealed that overall survival (OS) and progression-free survival (PFS) of patients with osteosarcoma in the limb-salvage treatment group were significantly longer than those in the amputation treatment group [hazard ratio (HR)=0.71; 95% confidence interval (CI): 0.63-0.80; P=0.000 vs. HR=0.60; 95% CI: 0.48-0.76; P=0.000]. Additionally, the five-year OS rate for patients in the limb-salvage treatment group was higher than that in the amputation group [odds ratio (OR)=4.48; 95% CI: 2.74-7.31; P=0.000]. However, the local recurrence rate was notably higher in the limb-salvage treatment group compared with the amputation treatment group (OR=2.68; 95% CI: 1.50-4.77; P=0.001). Furthermore, the results indicated no significant difference in distant metastasis rates between the limb-salvage treatment group and the amputation treatment group (OR=0.32; 95% CI: 0.10-1.06; P=0.062). In conclusion, the present meta-analysis underscores the potential of limb-salvage therapy for adolescent patients with osteosarcoma. The OS and PFS of patients undergoing limb-salvage surgery are longer than those of amputation, with a higher five-year OS rate and a similar rate of distant metastasis. However, the local recurrence rate of limb-salvage surgery is significantly higher than that of amputation.