Clinical and pathological characteristics and outcomes of osteosarcoma at Kenyatta National Hospital, Nairobi: A retrospective chart review

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Background: Osteosarcoma is the most common primary malignant bone tumour, predominantly affecting children and young adults. The burden of the disease is especially high in resource-limited settings, where late diagnosis, limited treatment options, and poor outcomes are frequent.Objective: This study aimed to provide a comprehensive review of the clinical and pathological characteristics, treatment modalities, and survival outcomes of patients with osteosarcoma treated at Kenyatta National Hospital (KNH) between 2013 and 2022.Methods: We conducted a retrospective chart review of osteosarcoma patients treated at KNH. Patient demographics, tumour characteristics, treatment interventions, and outcomes were collected from hospital records. Descriptive statistics summarized the data, and overall survival was estimated with the Kaplan-Meier method, censoring patients lost to follow-up at last documented contact. Statistical significance was set at p < 0.05.Results: The study included 81 patients, with a male-to-female ratio of 1.3:1 and a mean age of 22.2 years. The majority (95.1%) of tumours were located in the extremities, and 58% of patients presented with metastatic disease at diagnosis, most commonly to the lungs (51.9%). All cases were histologically confirmed, but the subtype was not specified on the pathology report in 82.7% and the grade in 63.0%. Surgical treatment was performed in 66.7% of cases, of whom 96.3% underwent amputation and only 3.7% limb-salvage surgery. Chemotherapy was administered to 79% of patients, typically consisting of doxorubicin and cisplatin. The overall median survival time was 14 months, and survival was substantially poorer than international benchmarks.Conclusion: This study highlights the challenges in managing osteosarcoma in a resource-limited setting. Late diagnosis, limited use of limb-salvage surgery, and poor survival outcomes reflect critical gaps in osteosarcoma care in Kenya. Improved healthcare infrastructure, early detection strategies, and access to comprehensive multimodal treatment are essential for enhancing patient outcomes.