Background/Objectives: The quality of surgical margins has been shown to be a prognostic factor in many sarcoma entities, yet its role in osteosarcoma remains controversial. While previous studies have shown that the outcome was not related to the margin width in bone, the impact of the extraosseous margin width (margin at the soft tissue invasion)—which needs to be close sometimes due to neurovascular structures—needs to be assessed. This study aims to evaluate the influence of soft tissue surgical margins on local recurrence and overall survival in patients with high-grade osteosarcoma. Methods: We conducted a retrospective, single-center study including 75 patients treated for high-grade osteosarcoma. All patients underwent standardized neoadjuvant chemotherapy followed by complete surgical resection. Patients were stratified into three groups based on the histological margin width of the extraosseous parts: group 1 (<1 mm), group 2 (1–5 mm), and group 3 (≥5 mm). Primary endpoints were local recurrence and overall survival (OS), analyzed using Kaplan–Meier estimates, log-rank tests, and Cox regression. Results: Local recurrence occurred in seven patients (9%). Although the overall comparison between the three groups was not statistically significant (p= 0.074), a subgroup analysis revealed a significantly higher recurrence rate in patients with margins < 1 mm compared to those with wider margins (p= 0.024). No significant differences in overall survival (OS) were observed between the groups (p= 0.896). Tumor location, metastatic status, and UICC stage were significant predictors for both endpoints in univariate analysis. However, none of these association were confirmed in multivariate analyses. Conclusions: Very close surgical margins (<1 mm) may increase the risk of local recurrence in high-grade osteosarcoma; however, they do not appear to affect overall survival.
背景/目的：手术切缘质量已被证实是多种肉瘤的预后因素，但其在骨肉瘤中的作用仍存争议。既往研究表明骨内切缘宽度与预后无关，然而由于神经血管结构的存在有时需采用较窄切缘，因此骨外切缘（软组织浸润处切缘）宽度的影响有待评估。本研究旨在评估软组织手术切缘对高级别骨肉瘤患者局部复发和总生存期的影响。方法：我们开展了一项回顾性单中心研究，纳入75例接受治疗的高级别骨肉瘤患者。所有患者均接受标准化新辅助化疗后行完整手术切除。根据骨外部分组织学切缘宽度将患者分为三组：第1组（<1毫米）、第2组（1-5毫米）和第3组（≥5毫米）。主要终点为局部复发和总生存期（OS），采用Kaplan-Meier估计、对数秩检验和Cox回归进行分析。结果：7例患者（9%）出现局部复发。虽然三组间总体比较无统计学意义（p=0.074），但亚组分析显示切缘<1毫米患者的复发率显著高于较宽切缘患者（p=0.024）。各组间总生存期（OS）无显著差异（p=0.896）。单因素分析显示肿瘤位置、转移状态和UICC分期是两个终点的重要预测因素，但多因素分析未证实这些关联。结论：极窄手术切缘（<1毫米）可能增加高级别骨肉瘤局部复发风险，但似乎不影响总生存期。
Surgical Margin Analysis in Osteosarcoma: Impact on Survival and Local Control
肿瘤(癌症)患者之家