Survival in Chondrosarcoma Patients Treated with Limb-Salvage Surgery and Limb Amputation

Background: Chondrosarcoma is the third most common primary bone malignancy.For tumors located within the extremities, surgeons must choose between limb-salvage surgery (LSS) and limb amputation (LA) to achieve sufficient resection margins.The outcomes from these procedures in chondrosarcoma patients has limited descriptions in current literature.Aims and Objectives: To conduct a multivariate survival analysis of overall and malignancy-related outcomes in chondrosarcoma patients based off the use of LSS or LA.Study Design: Retrospective Cohort Study.Setting: A national cancer database analysis performed at UTMB Galveston.Materials and Methods: Initial cases of chondrosarcoma diagnosed between 2000-2010 from the National Cancer Institute's Surveillance, Epidemiology and End Results database were used for this study.Patients treated with LSS and LA were included.Demographic, tumor characteristic, treatment and survival data were extracted.Statistics: Descriptive statistics were calculated using Fisher exact test.All-cause and malignancy-related mortality were compared using Kaplan Meier analysis and multivariate cox regression.Adjusted covariates included: age, race, sex, ICD-O-3 histology, primary site, grade, summary stage, laterality, use of radiation/chemotherapy.Results: 550 cases with a mean follow up time of 93.14 months (+/-55.02)were included.104 patients received LA and 446 received LSS.Kaplan Meier analysis showed that overall (p < .001)and malignancy-related (p = .003)survival were poorer for LA patients.Upon multivariate cox regression, adjusted all-cause mortality risk was significantly higher for patients treated with amputation (HR, 1.672; p = .004)compared to limb-salvage surgery.However, adjusted malignancy-related mortality did not significantly differ between the two treatment groups (p = .167).Conclusions: Malignancy-related outcomes are equivocal for LSS and LA, however all-cause mortality is significantly worse for LA patients.Less functional debilitation from LSS may allow for a better quality of life and overall health compared to amputation explaining differences in all-cause mortality.