Publication:

Histologic grade and surgical margin status as prognostic factors in chondrosarcoma: a retrospective single-center study

Background Chondrosarcoma is a malignant cartilage-producing bone tumor in which prognosis is influenced by tumor biology and adequacy of surgical treatment. Histologic grade and surgical margin status are considered major prognostic factors. This study evaluated their impact in a retrospective institutional series.

Methods Patients diagnosed with and treated for chondrosarcoma at a tertiary referral centre between 1986 and 2008 were retrospectively reviewed. Clinical, radiologic, pathologic, treatment, and follow-up data were analysed. Variables included tumour origin, location, histologic grade, Enneking stage, pulmonary metastasis at diagnosis, soft-tissue extension, surgical treatment, margin status, local recurrence, and survival. Associations were analysed using chi-square tests.

Results A total of 144 patients were included (mean age 42.1±15.0 years; 57.6% male). Pulmonary metastasis at diagnosis was present in 10 patients (6.9%), and soft-tissue extension was identified in 61 (42.4%). Soft-tissue extension was significantly associated with pulmonary metastasis at presentation (p=0.002). Histologic grade and stage data were available for 110 patients; 54.5% had grade 1, 32.7% grade 2, and 12.7% grade 3 tumors. Local recurrence developed in 25 patients. Recurrence was observed in 58.8% of patients with positive surgical margins. In tumors with available grading data, recurrence occurred in 10.0% of grade 1, 36.1% of grade 2, and 35.7% of grade 3 lesions (p=0.004). Soft-tissue extension was also associated with recurrence (p=0.009). Overall mortality was 8.3%.

Conclusions Histologic grade and surgical margin status were the main determinants of outcome in this series. Soft-tissue extension was associated with both recurrence and pulmonary metastasis at diagnosis.