Meta-analysis Of Limb Salvage Versus Amputation For Treating High-grade And Localized Osteosarcoma In Patients With Pathological Fracture

Objective: The goal of this study was to determine outcomes related to limb salvage vs.amputation for treating high-grade and localized osteosarcoma in patients withpathological fractures. Methods: The literature，published from1996to2010whichcompare limb salvage and amputation of high-grade and localized osteosarcoma inpatients with pathological fractures were collected．To deal with the5-year survival rate、local recurrence and metastatic occurrence．Results: Literature search was conductedusing Medline, Embase and the Cochrane Database. Two reviewers independentlyassessed all eligible publications. The primary outcome measurement was pooled oddsratio (OR) and95%confidence interval (CI) for the risk of local recurrence,5-year overallsurvival rate and metastatic occurrence calculated through the fixed-effects method. Seveneligible studies were identified, which included a total of284patients. The risk for localrecurrence and5-year overall survival rate did not differ significantly (P>0.05) betweenthe limb salvage group and amputation group, with an OR of1.48(95%CI,0.67–3.30)and1.85(95%CI,0.86–3.98), respectively. The risk for metastatic occurrence differedsignificantly (P<0.05), with an OR of0.30(95%CI,0.10–0.91). The occurrence of apathological fracture is not regarded as an absolute contraindication to limb salvage inpatients with high-grade and localized osteosarcoma. Conclusion: Limb salvage as analternative for treating high-grade and localized osteosarcoma in patients withpathological fracture does not greatly increase the risk for local recurrence or5-yearoverall survival rate compared to amputation and has a lower risk for metastaticoccurrence.