Pathological fractures as an adverse prognostic factor in chondrosarcoma: Results of a systematic review, meta-analysis and institutional case series

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Background: Pathological fractures are recognized as a potential, adverse prognostic factor in primary bone sarcomas. While some studies suggest higher recurrence rates and reduced survival, robust data specific to chondrosarcoma (CS) remain limited. This study evaluates the prognostic relevance of pathological fractures (PF) in CS patients. Additionally, clinical data from an institutional cohort was analyzed retrospectively. Results: Nine studies, with a total of 1,185 patients and 245 PF cases, met the inclusion criteria. Meta-analysis revealed that PF status was significantly associated with inferior survival at 1-5 years (pooled OR 0.40; 95 % CI 0.26-0.62; p < 0.0001). The increased risk of death was particularly evident in dedifferentiated CS (pooled HR 1.96; 95 % CI 1.46-2.63; p < 0.00001). Institutional data supported these findings, that PF was associated with worse overall survival (HR 3.90; 95 % CI 0.69-21.98; p = 0.12) and progression-free survival (HR 3.17; 95 % CI 0.58-17.36; p = 0.18), although significance was limited by sample size. These results underscore the importance of personalized surgical management and intensive outcome monitoring for CS patients presenting with PF.