Abstract
Aim
To determine whether delayed diagnosis (lapse from initial symptoms to the beginning of treatment) has influence on the possibilities of crossing the physis by the tumour, and/or on the outcome in pediatric patients with high grade metaphyseal osteosarcoma.
Patients and methods
The clinical records, image methods and the histology reports of 157 metaphyseal paediatric osteosarcomas were reviewed. The mean follow-up time was 102 months. Location, histological subtype, time from initial symptoms to start of treatment, major diameter, % of necrosis, physis crossed by the tumour or not, and outcome (recurrence, metastases and status) were recorded in a SPSS v15.0 file.
Results
The tumour crossed the physis in 58% of patients. There were statistically significant differences in the age, time from initial symptoms to start of treatment, presence of metastases at diagnosis and outcome between patients affected by tumours crossing the physis and those which did not. Major diameter had no relationship with survival nor delay in diagnosis.
Conclusion
The crossing of the physis by a metaphyseal paediatric OS is a matter of time. The outcome of tumours which crossed the physis was worse than that of those which did not. Delay (>2months) between initial symptoms and start of treatment is a poor prognostic factor. The younger the patient, the higher the possibilities of epiphyseal preservation. A major effort should be done to achieve early diagnosis.
