Rak kości – Rokowania, prognozy i postęp choroby

Rak kości
Rokowania, prognozy i postęp choroby

Rokowanie w raku kości jest złożone i zależy od wielu czynników klinicznych, takich jak obecność i lokalizacja przerzutów, wielkość guza (z progowym rozmiarem 8 cm), stopień złośliwości, wiek pacjenta (lepsze rokowanie u osób <40 lat) oraz odpowiedź na chemioterapię (np. Huvos I z <50% martwicy guza wiąże się z medianą EFS 25 miesięcy). Pięcioletnie wskaźniki przeżycia różnią się w zależności od typu i stadium nowotworu: w Kanadzie wynoszą około 62%, w USA dla mięsaków kości 66,9%, a w Anglii dla wszystkich nowotworów kości około 70%. Dla kostniakomięsaków i mięsaków Ewinga zlokalizowanych 5-letni wskaźnik przeżycia wynosi 60-80%, a dla chrzęstniakomięsaków około 80%. Nowoczesne modele prognostyczne, takie jak nomogramy uwzględniające siedem niezależnych czynników (wiek, typ histologiczny, operacja, wielkość guza, miejscowe rozprzestrzenianie, inwazja węzłów chłonnych, przerzuty odległe) oraz kalkulatory oparte na random forest, pozwalają na lepszą stratifikację ryzyka i personalizację leczenia.

Prognoza raka kości (Rak kości: Rokowanie)

Ogólne wskaźniki przeżycia
Czynniki wpływające na rokowanie
Modele prognostyczne i stratyfikacja ryzyka
Metaboliczna objętość guza w przewidywaniu wyników leczenia
Interpretacja statystyk przeżycia
Perspektywy leczenia i rokowania
Kolejne rozdziały

Prognoza raka kości (Rak kości: Rokowanie)

Rokowanie w przypadku raka kości jest indywidualną oceną przewidywanego przebiegu choroby i odpowiedzi na leczenie. Prognozy opierają się na wielu czynnikach i tylko lekarz znający szczegółową historię medyczną pacjenta, typ i stadium nowotworu oraz inne cechy charakterystyczne choroby, zastosowane leczenie i odpowiedź na nie, może połączyć wszystkie te informacje ze statystykami przeżycia, aby określić rokowanie¹². Warto podkreślić, że wskaźniki przeżycia dla raka kości są ogólnymi szacunkami i należy je interpretować bardzo ostrożnie³.

Ogólne wskaźniki przeżycia

W Kanadzie 5-letnie przeżycie netto dla raka kości wynosi około 62%. Oznacza to, że około 62% osób z rozpoznaniem raka kości przeżyje co najmniej 5 lat⁴. Według danych opublikowanych przez Narodowy Instytut Raka (NCI) w USA, ogólny 5-letni wskaźnik przeżycia dla mięsaków kości wynosi 66,9%⁵. W Anglii, dla wszystkich stadiów mięsaka kości, statystyki pokazują, że około 85 na 100 osób (około 85%) przeżywa swoją chorobę nowotworową przez 1 rok lub dłużej, a ponad 65 na 100 osób (ponad 65%) przeżywa 5 lat lub dłużej⁶.

Dla wszystkich dorosłych nowotworów kości łącznie, 5-letni wskaźnik przeżycia wynosi około 70%. Jednakże wartość ta różni się w zależności od typu nowotworu i stadium zaawansowania⁷. Dla kostniakomięsaków i mięsaków Ewinga, które są nadal zlokalizowane w miejscu, gdzie się rozpoczęły (nowotwór zlokalizowany), 5-letni wskaźnik przeżycia wynosi około 60-80%⁸. W przypadku chrzęstniakomięsaków u dorosłych, 5-letni wskaźnik przeżycia wynosi około 80%⁹.

Czynniki wpływające na rokowanie

Najważniejsze czynniki prognostyczne w raku kości obejmują:

Obecność przerzutów – czy nowotwór zdążył się rozprzestrzenić w momencie diagnozy jest najważniejszym czynnikiem prognostycznym dla raka kości. Obecność przerzutów wiąże się z gorszym rokowaniem¹⁰.
Lokalizacja przerzutów – rak kości, który rozprzestrzenił się tylko do płuc, ma lepsze rokowanie niż przerzuty do innych części ciała¹¹.
Lokalizacja guza pierwotnego – guzy zlokalizowane w kościach nogi lub ramienia (guzy dystalne) mają lepsze rokowanie niż guzy znajdujące się w kościach miednicy, klatki piersiowej, czaszki lub kręgosłupa (guzy proksymalne)¹².
Stopień złośliwości – guzy o niskim stopniu złośliwości mają lepsze rokowanie niż guzy o wysokim stopniu złośliwości¹³.
Wielkość guza – guzy raka kości mniejsze niż 8 cm mają lepsze rokowanie niż guzy większe niż 8 cm¹⁴.
Wiek pacjenta – osoby, które są młodsze niż 40 lat w momencie diagnozy raka kości, mają lepsze rokowanie niż osoby powyżej 40 roku życia¹⁵.
Odpowiedź na chemioterapię – stopień zmniejszenia guza raka kości pod wpływem chemioterapii wpływa na rokowanie. Guzy, które dobrze reagują i zmniejszają się pod wpływem chemioterapii, mają lepsze rokowanie niż guzy, które nie reagują dobrze na chemioterapię¹⁶¹⁷. Pacjenci z rakiem kości zlokalizowanym, którzy mają mniej niż 50% martwicy guza w odpowiedzi na chemioterapię (Huvos I), mają wyjątkowo złe rokowanie z medianą EFS (Event-Free Survival – przeżycie wolne od zdarzeń) wynoszącą zaledwie 25 miesięcy¹⁸.

Modele prognostyczne i stratyfikacja ryzyka

W ostatnich latach opracowano różne modele prognostyczne mające na celu dokładniejsze przewidywanie przebiegu choroby i identyfikację pacjentów wysokiego ryzyka. Rozwój tych narzędzi ma kluczowe znaczenie dla personalizacji leczenia i poprawy komunikacji między lekarzami a pacjentami¹⁹²⁰.

Nomogram dla kostniakomięsaka kości długich

Opracowano nomogram oparty na czynnikach kliniczno-patologicznych wpływających na rokowanie pacjentów z pierwotnym kostniakomięsakiem kości długich (PLBOS). Zidentyfikowano siedem niezależnych czynników prognostycznych²¹:

Wiek
Typ histologiczny
Operacja ogniska pierwotnego
Wielkość guza
Miejscowe rozprzestrzenianie się
Inwazja regionalnych węzłów chłonnych
Przerzuty odległe

System stratyfikacji ryzyka oparty na nomogramie wykazał istotne różnice w przeżyciu specyficznym dla raka (CSS – Cancer-Specific Survival) między różnymi grupami ryzyka. Model ten może pomóc klinicystom w ocenie rokowań, identyfikacji osób z grupy wysokiego ryzyka i udzielaniu zindywidualizowanych zaleceń dotyczących leczenia pacjentów z PLBOS²².

Kalkulator internetowy do przewidywania śmiertelności w przerzutach do kości

Opracowano kalkulator internetowy oparty na modelu lasu losowego (random forest) do oszacowania trzymiesięcznej śmiertelności wśród pacjentów z przerzutami do kości z nieznanego ogniska pierwotnego (CUP – Cancer of Unknown Primary). W całej kohorcie pacjentów aż 72,38% zmarło w ciągu trzech miesięcy lub wcześniej, a odsetek ten był znacznie wyższy w porównaniu z pacjentami z innymi nowotworami²³.

Analiza wieloczynnikowa wykazała, że starszy wiek, przerzuty do płuc i przerzuty do wątroby były czynnikami ryzyka trzymiesięcznej śmiertelności, podczas gdy radioterapia i chemioterapia były czynnikami ochronnymi. W porównaniu z pacjentami z grup niskiego ryzyka, pacjenci z grup wysokiego ryzyka mieli 1,99 razy wyższe prawdopodobieństwo zgonu w ciągu trzech miesięcy w kohorcie walidacji wewnętrznej i 2,37 razy wyższe prawdopodobieństwo w kohorcie walidacji zewnętrznej²⁴.

Klasyfikacja ryzyka pacjentów umożliwiła podział na dwie kategorie ryzyka w oparciu o optymalny próg, co pozwala na spersonalizowane wdrożenie strategii terapeutycznych²⁵.

Sygnatura genowa do przewidywania rokowania

Zidentyfikowano sygnaturę genową składającą się z 13 genów, która może przewidywać złe rokowanie u pacjentów ze zlokalizowanym kostniakomięsakiem. Sygnatura ta była istotnie skorelowana z czasem do zgonu u pacjentów ze zlokalizowanym nowotworem i okazała się bardziej skuteczna w identyfikacji pacjentów ze zlokalizowanym nowotworem o złym rokowaniu zarówno w ciągu 3, jak i 5 lat od diagnozy²⁶.

Dane wskazują na szlak sygnałowy Hedgehog jako potencjalny cel terapeutyczny dla poprawy wyników leczenia pacjentów wysokiego ryzyka bez przerzutów²⁷.

Model oparty na zdysregulowanych szlakach (DPBM)

Zaproponowano model przewidywania oparty na zdysregulowanych szlakach (DPBM – Dysregulated Pathway Based prediction Model) do przewidywania ryzyka przerzutów do kości u pacjentów z rakiem piersi. Wyniki walidacji na zestawie testowym i niezależnym zestawie wykazały dużą moc predykcyjną DPBM²⁸.

Główną różnicą między genami zdysregulowanymi w przerzutach do kości a genami zdysregulowanymi w przerzutach do innych narządów było to, że te pierwsze były również wzbogacone w procesach biologicznych związanych z układem immunologicznym. Ta różnica sugeruje, że układ immunologiczny może mieć kluczowe znaczenie w specyficznych dla kości przerzutach raka piersi²⁹.

Metaboliczna objętość guza w przewidywaniu wyników leczenia

Oceniono zdolność parametrów metabolicznych i objętościowych mierzonych za pomocą przedterapeutycznego badania 18F-FDG PET/CT do przewidywania przeżycia pacjentów z kostniakomięsakiem kończyn. Metaboliczna objętość guza (MTV – Metabolic Tumor Volume) okazała się niezależnym czynnikiem predykcyjnym przerzutów u pacjentów z kostniakomięsakiem kończyn³⁰.

Stwierdzono, że stały próg SUV (Standardized Uptake Value) wynoszący 2,0 jest odpowiedni do pomiaru MTV, która odzwierciedla biologicznie aktywne obciążenie nowotworowe u pacjentów z kostniakomięsakiem³¹.

Stratyfikacja pacjentów według połączonych kryteriów MTV i odpowiedzi histologicznej może zapewnić bardziej szczegółowe przewidywanie wyniku klinicznego niż sama MTV lub sama odpowiedź histologiczna. Kombinacja MTV i odpowiedzi histologicznej przewiduje przeżycie dokładniej niż sama odpowiedź histologiczna³².

Interpretacja statystyk przeżycia

Należy pamiętać, że wskaźniki przeżycia są szacunkami i często opierają się na wcześniejszych wynikach dużej liczby osób z określonym typem raka, ale nie mogą przewidzieć, co stanie się w konkretnym przypadku³³. Te statystyki mogą być mylące i mogą budzić więcej pytań. Zawsze warto zapytać lekarza, jak te liczby mogą odnosić się do indywidualnego przypadku³⁴.

Ważne jest zrozumienie, że te liczby dotyczą tylko stadium raka w momencie pierwszej diagnozy. Nie mają zastosowania później, jeśli rak rośnie, rozprzestrzenia się lub nawraca po leczeniu³⁵.

Ponadto, te liczby nie uwzględniają wszystkiego. Wskaźniki przeżycia są grupowane na podstawie typu raka kości i tego, jak daleko się rozprzestrzenił. Jednak inne czynniki, takie jak wiek i ogólny stan zdrowia, która kość została początkowo dotknięta nowotworem oraz jak dobrze rak reaguje na leczenie, również mogą wpływać na rokowanie³⁶.

Osoby, które obecnie są diagnozowane z rakiem kości, mogą mieć lepsze rokowanie niż wskazują te liczby. Leczenie ulega poprawie z czasem, a te liczby opierają się na osobach, które zostały zdiagnozowane i leczone co najmniej 5 lat wcześniej³⁷.

Perspektywy leczenia i rokowania

Leczenie nowotworów kości jest często skuteczne. W wielu przypadkach nowotwór nigdy nie powraca. Może być konieczne przeprowadzenie jednej lub więcej operacji, aby osiągnąć ten wynik³⁸. Szansa na wyzdrowienie w przypadku nowotworów kości poprawiła się w ostatnich latach dzięki nowym i lepszym metodom leczenia³⁹.

Ostatecznie, każdy przypadek jest inny i nie ma jednego wyniku, który dotyczyłby wszystkich osób z rakiem kości. Lekarz może wyjaśnić rokowanie (perspektywę) na podstawie typu raka, jego stadium, lokalizacji i odpowiedzi na leczenie⁴⁰.

Chociaż nowotwory kości mogą być śmiertelne, wiele osób całkowicie wraca do zdrowia. Pięcioletni względny wskaźnik przeżycia dla raka kości wynosi 68,2%. Oznacza to, że 68,2% osób z rakiem kości żyje pięć lat po diagnozie. Osoby z nowotworami kości o niższym stadium mają większą szansę na pełny powrót do zdrowia. W przypadku osób z nowotworami kości o wyższym stadium, gdzie już doszło do rozprzestrzenienia, zwiększa się prawdopodobieństwo nawrotu nowotworu⁴¹.

Kolejne rozdziały

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Materiały źródłowe

#1 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
If you have bone cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] Whether or not cancer has already spread when it is diagnosed is the most important prognostic factor for bone cancer. Metastasis is linked with a poorer prognosis. […] Where the cancer has spread is also an important prognostic factor. Bone cancer that has spread only to the lungs has a better prognosis than metastasis to other parts of the body.
#2 Survival statistics for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival/survival-statistics
Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for bone cancer is 62%. This means that about 62% of people diagnosed with bone cancer will survive for at least 5 years. […] Generally, the earlier bone cancer is diagnosed and treated, the better the outcome. […] Survival by tumour type for bone cancer is reported as 5-year relative survival. […] Research comparing studies looking at survival rates for adult Ewing sarcoma have shown 5-year relative survival between 41% and 58%. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#3 Survival statistics for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival/survival-statistics
Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for bone cancer is 62%. This means that about 62% of people diagnosed with bone cancer will survive for at least 5 years. […] Generally, the earlier bone cancer is diagnosed and treated, the better the outcome. […] Survival by tumour type for bone cancer is reported as 5-year relative survival. […] Research comparing studies looking at survival rates for adult Ewing sarcoma have shown 5-year relative survival between 41% and 58%. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#4 Survival statistics for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival/survival-statistics
Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival. […] In Canada, the 5-year net survival for bone cancer is 62%. This means that about 62% of people diagnosed with bone cancer will survive for at least 5 years. […] Generally, the earlier bone cancer is diagnosed and treated, the better the outcome. […] Survival by tumour type for bone cancer is reported as 5-year relative survival. […] Research comparing studies looking at survival rates for adult Ewing sarcoma have shown 5-year relative survival between 41% and 58%. […] Only a doctor familiar with these factors can put all of this information together with survival statistics to arrive at a prognosis.
#5 Sarcoma – Wikipedia
https://en.wikipedia.org/wiki/Sarcoma
The AJCC has identified several factors that affect prognosis of bone sarcomas: […] According to data published by the US National Cancer Institute (NCI), the overall 5-year survival for bone sarcomas is 66.9%. […] For soft-tissue sarcomas, the overall 5-year survival (irrespective of stage) is 64.5%, but survival is affected by many factors, including stage. […] Thus, the 5-year survival is 80.8% for soft-tissue sarcomas that have not spread beyond the primary tumor („localized” tumors), 58.0% for soft-tissue sarcomas that have spread only to nearby lymph nodes, and 16.4% for soft-tissue sarcomas that have spread to distant organs.
#6 Survival for bone cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/bone-cancer/survival
Survival depends on different factors. So no one can tell you exactly how long you will live. […] Doctors usually work out the outlook for a certain disease by looking at large groups of people. Because this cancer is less common, survival estimates are more uncertain than for other, more common cancers. […] Your doctor can give you more information about your own outlook (prognosis). […] The statistics on this page are for primary bone cancer. […] The terms 1 year survival and 5 year survival don’t mean that you will only live for 1 or 5 years. […] 5 year survival is the number of people who have not died from their cancer within 5 years after diagnosis. […] There are no UK-wide statistics available for bone sarcoma survival by stage. These statistics are for people diagnosed between 2014 and 2016 for all stages of bone sarcoma in England: around 85 out of 100 people (around 85%) survive their cancer for 1 year or more, more than 65 out of 100 people (more than 65%) survive their cancer for 5 years or more.
#7 Primary Bone Cancer: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/primary-bone-cancer-your-chances-recovery-prognosis
For all adult bone cancers combined, the 5-year survival rate is about 70 percent. However, this varies by cancer type and stage. […] For osteosarcomas and Ewing sarcomas that are still in the area where they started (localized), the 5-year survival rate is about 60 to 80 percent. […] For adult chondrosarcomas, the 5-year survival rate is about 80 percent. […] Talk with your healthcare provider about survival rates and what you might expect.
#8 Primary Bone Cancer: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/primary-bone-cancer-your-chances-recovery-prognosis
For all adult bone cancers combined, the 5-year survival rate is about 70 percent. However, this varies by cancer type and stage. […] For osteosarcomas and Ewing sarcomas that are still in the area where they started (localized), the 5-year survival rate is about 60 to 80 percent. […] For adult chondrosarcomas, the 5-year survival rate is about 80 percent. […] Talk with your healthcare provider about survival rates and what you might expect.
#9 Primary Bone Cancer: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/primary-bone-cancer-your-chances-recovery-prognosis
For all adult bone cancers combined, the 5-year survival rate is about 70 percent. However, this varies by cancer type and stage. […] For osteosarcomas and Ewing sarcomas that are still in the area where they started (localized), the 5-year survival rate is about 60 to 80 percent. […] For adult chondrosarcomas, the 5-year survival rate is about 80 percent. […] Talk with your healthcare provider about survival rates and what you might expect.
#10 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
If you have bone cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] Whether or not cancer has already spread when it is diagnosed is the most important prognostic factor for bone cancer. Metastasis is linked with a poorer prognosis. […] Where the cancer has spread is also an important prognostic factor. Bone cancer that has spread only to the lungs has a better prognosis than metastasis to other parts of the body.
#11 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
If you have bone cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis. […] Whether or not cancer has already spread when it is diagnosed is the most important prognostic factor for bone cancer. Metastasis is linked with a poorer prognosis. […] Where the cancer has spread is also an important prognostic factor. Bone cancer that has spread only to the lungs has a better prognosis than metastasis to other parts of the body.
#12 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
Tumours that are found in the bones of the leg or arm (distal tumours) have a better prognosis than tumours that are found in the bones of the pelvis, chest, skull or spine (proximal tumours). […] Low-grade tumours have a better prognosis than high-grade tumours. […] Bone cancer tumours that are smaller than 8 cm have a better prognosis than tumours larger than 8 cm. […] People who are younger than 40 when they are diagnosed with bone cancer have a better prognosis than people over age 40. […] The amount that a bone cancer tumour shrinks with chemotherapy affects the prognosis. Tumours that respond well and get smaller with chemotherapy have a better prognosis than tumours that do not respond very well to chemotherapy. […] Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
#13 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
Tumours that are found in the bones of the leg or arm (distal tumours) have a better prognosis than tumours that are found in the bones of the pelvis, chest, skull or spine (proximal tumours). […] Low-grade tumours have a better prognosis than high-grade tumours. […] Bone cancer tumours that are smaller than 8 cm have a better prognosis than tumours larger than 8 cm. […] People who are younger than 40 when they are diagnosed with bone cancer have a better prognosis than people over age 40. […] The amount that a bone cancer tumour shrinks with chemotherapy affects the prognosis. Tumours that respond well and get smaller with chemotherapy have a better prognosis than tumours that do not respond very well to chemotherapy. […] Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
#14 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
Tumours that are found in the bones of the leg or arm (distal tumours) have a better prognosis than tumours that are found in the bones of the pelvis, chest, skull or spine (proximal tumours). […] Low-grade tumours have a better prognosis than high-grade tumours. […] Bone cancer tumours that are smaller than 8 cm have a better prognosis than tumours larger than 8 cm. […] People who are younger than 40 when they are diagnosed with bone cancer have a better prognosis than people over age 40. […] The amount that a bone cancer tumour shrinks with chemotherapy affects the prognosis. Tumours that respond well and get smaller with chemotherapy have a better prognosis than tumours that do not respond very well to chemotherapy. […] Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
#15 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
Tumours that are found in the bones of the leg or arm (distal tumours) have a better prognosis than tumours that are found in the bones of the pelvis, chest, skull or spine (proximal tumours). […] Low-grade tumours have a better prognosis than high-grade tumours. […] Bone cancer tumours that are smaller than 8 cm have a better prognosis than tumours larger than 8 cm. […] People who are younger than 40 when they are diagnosed with bone cancer have a better prognosis than people over age 40. […] The amount that a bone cancer tumour shrinks with chemotherapy affects the prognosis. Tumours that respond well and get smaller with chemotherapy have a better prognosis than tumours that do not respond very well to chemotherapy. […] Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
#16 Prognosis and survival for bone cancer | Canadian Cancer Society
https://cancer.ca/en/cancer-information/cancer-types/bone/prognosis-and-survival
Tumours that are found in the bones of the leg or arm (distal tumours) have a better prognosis than tumours that are found in the bones of the pelvis, chest, skull or spine (proximal tumours). […] Low-grade tumours have a better prognosis than high-grade tumours. […] Bone cancer tumours that are smaller than 8 cm have a better prognosis than tumours larger than 8 cm. […] People who are younger than 40 when they are diagnosed with bone cancer have a better prognosis than people over age 40. […] The amount that a bone cancer tumour shrinks with chemotherapy affects the prognosis. Tumours that respond well and get smaller with chemotherapy have a better prognosis than tumours that do not respond very well to chemotherapy. […] Survival statistics for bone cancer are very general estimates and must be interpreted very carefully. Because these statistics are based on the experience of groups of people, they cannot be used to predict a particular persons chances of survival.
#17 Survival for bone cancer | Cancer Research UK
https://www.cancerresearchuk.org/about-cancer/bone-cancer/survival
Please remember that these statistics are for everybody diagnosed with each type of cancer. The figures do not take into account other factors that affect your survival, such as the stage and grade of your cancer, your age, where the cancer is, or how well treatment works. Your doctor can tell you more about your own outlook. […] Your outlook depends on the stage of the cancer when it was diagnosed. This means how big it is and whether it has spread. […] Survival is also affected by where the cancer is in your body. […] If you have chemotherapy before surgery, the doctors will look at your tumour to see how well it has responded to chemotherapy. If you have a good response your outlook is better.
#18 Identification of an early survival prognostic gene signature for localized osteosarcoma patients | Scientific Reports
https://www.nature.com/articles/s41598-024-57527-8
Osteosarcoma is the most prevalent bone tumor in pediatric patients. Neoadjuvant chemotherapy has improved osteosarcoma patient survival, however the 5-year survival rate for localized osteosarcoma is 75% with a 30-50% recurrence rate. We, therefore, sought to identify a prognostic gene signature which could predict poor prognosis in localized osteosarcoma patients. […] We further show that our signature outperforms previously reported signatures in predicting poor prognosis and death within 3 years in patients with localized osteosarcoma. […] To date the most common predictive measure of localized tumor response to chemotherapy is percent tumor necrosis. Patients with localized osteosarcoma that have less than 50% tumor necrosis in response to chemotherapy (Huvos I) have extremely poor prognosis with a median EFS of only 25 months, thus it is imperative to understand the mechanisms contributing to poor prognosis and relapse.
#19 A predictive model with a risk-classification system for cancer-specific survival in patients with primary osteosarcoma of long bone
https://pmc.ncbi.nlm.nih.gov/articles/PMC8844746/
Seven clinical factors were significantly related to the prognosis of patients with long bone osteosarcoma. […] The established nomogram can help surgeons evaluate the prognosis of osteosarcoma patients in the most common sites. […] High-risk individuals can be identified through risk-stratification system. […] We aimed to develop a nomogram based on the clinicopathological factors affecting the prognosis of PLBOS patients to help clinicians predict the cancer-specific survival (CSS) of PLBOS patients. […] Age, Histological type, Surgery of primary site, Tumor size, Local extension, Regional lymph node (LN) invasion, and Distant metastasis were identified as independent prognostic factors. […] The risk-stratification system based on the nomogram showed significant differences (P 0.05) in CSS among different risk groups.
#20 Development of a web-based calculator to predict three-month mortality among patients with bone metastases from cancer of unknown primary: An internally and externally validated study using machine-learning techniques
https://pmc.ncbi.nlm.nih.gov/articles/PMC9768185/
Individualized therapeutic strategies can be carried out under the guidance of expected lifespan, hence survival prediction is important. […] The objective of the study is to construct a model as well as a web-based calculator to predict three-month mortality among bone metastasis patients with CUP using machine learning-based techniques. […] The three-month mortality was 72.38% (731/1010) in the entire cohort. […] The multivariate analysis revealed that older age (P=0.031), lung metastasis (P=0.012), and liver metastasis (P=0.008) were risk contributors for three-month mortality, while radiation (P=0.002) and chemotherapy (P0.001) were protective factors. […] When compared to patients in the low-risk groups, patients in the high-risk groups had a 1.99 times higher chance of dying within three months in the internal validation cohort and a 2.37 times higher chance in the external validation cohort (Both P0.001).
#21 A predictive model with a risk-classification system for cancer-specific survival in patients with primary osteosarcoma of long bone
https://pmc.ncbi.nlm.nih.gov/articles/PMC8844746/
Seven clinical factors were significantly related to the prognosis of patients with long bone osteosarcoma. […] The established nomogram can help surgeons evaluate the prognosis of osteosarcoma patients in the most common sites. […] High-risk individuals can be identified through risk-stratification system. […] We aimed to develop a nomogram based on the clinicopathological factors affecting the prognosis of PLBOS patients to help clinicians predict the cancer-specific survival (CSS) of PLBOS patients. […] Age, Histological type, Surgery of primary site, Tumor size, Local extension, Regional lymph node (LN) invasion, and Distant metastasis were identified as independent prognostic factors. […] The risk-stratification system based on the nomogram showed significant differences (P 0.05) in CSS among different risk groups.
#22 A predictive model with a risk-classification system for cancer-specific survival in patients with primary osteosarcoma of long bone
https://pmc.ncbi.nlm.nih.gov/articles/PMC8844746/
We established a nomogram with risk-stratification system to predict CSS in PLBOS patients and demonstrated that the nomogram had good performance. […] This model can help clinicians evaluate prognoses, identify high-risk individuals, and give individualized treatment recommendation of PLBOS patients.
#23 Development of a web-based calculator to predict three-month mortality among patients with bone metastases from cancer of unknown primary: An internally and externally validated study using machine-learning techniques
https://pmc.ncbi.nlm.nih.gov/articles/PMC9768185/
This study suggests a web-based calculator based on the random forest model to estimate the three-month mortality among bone metastases from CUP, and it may be a helpful tool to direct clinical decision-making, inform patients about their prognosis, and facilitate therapeutic communication between patients and physicians. […] This study found that older age, lung metastasis, and liver metastasis were significant contributors for three-month mortality, with radiation and chemotherapy being protective factors for survival. […] In the entire cohort of patients, up to 72.38% patients passed away at or within three months, and this incidence was significantly higher as compared to that among patients with other cancers. […] The model was incorporated into a web-based calculator to encourage clinical reference and research use.
#24 Development of a web-based calculator to predict three-month mortality among patients with bone metastases from cancer of unknown primary: An internally and externally validated study using machine-learning techniques
https://pmc.ncbi.nlm.nih.gov/articles/PMC9768185/
Individualized therapeutic strategies can be carried out under the guidance of expected lifespan, hence survival prediction is important. […] The objective of the study is to construct a model as well as a web-based calculator to predict three-month mortality among bone metastasis patients with CUP using machine learning-based techniques. […] The three-month mortality was 72.38% (731/1010) in the entire cohort. […] The multivariate analysis revealed that older age (P=0.031), lung metastasis (P=0.012), and liver metastasis (P=0.008) were risk contributors for three-month mortality, while radiation (P=0.002) and chemotherapy (P0.001) were protective factors. […] When compared to patients in the low-risk groups, patients in the high-risk groups had a 1.99 times higher chance of dying within three months in the internal validation cohort and a 2.37 times higher chance in the external validation cohort (Both P0.001).
#25 Development of a web-based calculator to predict three-month mortality among patients with bone metastases from cancer of unknown primary: An internally and externally validated study using machine-learning techniques
https://pmc.ncbi.nlm.nih.gov/articles/PMC9768185/
Risk classification of patients was accomplished in the study, and patients could be split into two risk categories based on the ideal threshold, allowing for the personalized execution of therapeutic strategies. […] The random forest model has promising performance with favorable discrimination and calibration.
#26 Identification of an early survival prognostic gene signature for localized osteosarcoma patients | Scientific Reports
https://www.nature.com/articles/s41598-024-57527-8
Our data point to the Hedgehog signaling pathway as a candidate druggable cascade to improve outcomes for high-risk non-metastatic patients. […] The 13 gene signature was significantly correlated with time to death in the localized patients (p=0.048) similarly to the 963 DEG localized survival signature but not to the 1486 DEG relapse signature. […] These results suggest that the 13 genes could act as surrogate markers of the broader gene alterations noted in the overall survival localized gene signature. […] Our 13 gene hub signature, however, is more effective in identifying localized patients with poor prognosis within both 3- and 5- years of diagnosis.
#27 Identification of an early survival prognostic gene signature for localized osteosarcoma patients | Scientific Reports
https://www.nature.com/articles/s41598-024-57527-8
Our data point to the Hedgehog signaling pathway as a candidate druggable cascade to improve outcomes for high-risk non-metastatic patients. […] The 13 gene signature was significantly correlated with time to death in the localized patients (p=0.048) similarly to the 963 DEG localized survival signature but not to the 1486 DEG relapse signature. […] These results suggest that the 13 genes could act as surrogate markers of the broader gene alterations noted in the overall survival localized gene signature. […] Our 13 gene hub signature, however, is more effective in identifying localized patients with poor prognosis within both 3- and 5- years of diagnosis.
#28 A computational model to predict bone metastasis in breast cancer by integrating the dysregulated pathways | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-14-618
Although there are a lot of researches focusing on cancer prognosis or prediction of cancer metastases, it is still a big challenge to predict the risks of cancer metastasizing to a specific organ such as bone. […] Thus for cancer therapy, it is essential to identify the prognostic factors which can help to identify the patients with high risks of bone metastasis. […] In this work, we have proposed a Dysregulated Pathway Based prediction Model (DPBM) to address this problem. […] Validation results on test set and independent set have shown the great prediction power of DPBM. […] The facts that DPBM consistently performs well in both test set and independent set may be due to the following merits: (1) we used the pathways to filter the candidate genes, which can help to remove those genes less essential to the bone metastasis; (2) instead of selecting pathways or other functional gene sets via the activity differences between different phenotypes, we selected the dysregulated pathways enriched by the discriminative genes, which can help to preserve the useful information for classification and reduce noises; (3) we constructed one sub-model based on each dysregulated pathway, and then combined all sub-models by majority voting strategy. The ensemble classifier usually performs better than simple classifiers.
#29 A computational model to predict bone metastasis in breast cancer by integrating the dysregulated pathways | BMC Cancer | Full Text
https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-14-618
The main difference between these two kinds of dysregulated genes was that dysregulated genes of bone metastasis are also enriched in biological processes associated with immune system, whereas dysregulated genes of non-bone metastases were not. The difference suggests that the immune system may be essential in the bone specific metastasis of breast cancer.
#30 Initial Metabolic Tumor Volume Measured by 18F-FDG PET/CT Can Predict the Outcome of Osteosarcoma of the Extremities | Journal of Nuclear Medicine
https://jnm.snmjournals.org/content/54/10/1725
We evaluated the ability of metabolic and volumetric parameters measured by pretreatment 18F-FDG PET/CT to predict the survival of patients with osteosarcoma of the extremities. […] MTV is an independent predictor of metastasis in patients with osteosarcoma of the extremities. The combination of MTV and histologic response predicts survival more accurately than the chemotherapeutic response alone. […] A clinical staging system based on the tumor grade, size, and presence of skip lesions or distant metastases and the histologic response to neoadjuvant chemotherapy have been reported to be the most important predictors of survival. […] The results of this study suggest that a fixed SUV threshold of 2.0 is suitable for measuring MTV, which reflects the biologically active tumor burden in patients with osteosarcoma.
#31 Initial Metabolic Tumor Volume Measured by 18F-FDG PET/CT Can Predict the Outcome of Osteosarcoma of the Extremities | Journal of Nuclear Medicine
https://jnm.snmjournals.org/content/54/10/1725
We evaluated the ability of metabolic and volumetric parameters measured by pretreatment 18F-FDG PET/CT to predict the survival of patients with osteosarcoma of the extremities. […] MTV is an independent predictor of metastasis in patients with osteosarcoma of the extremities. The combination of MTV and histologic response predicts survival more accurately than the chemotherapeutic response alone. […] A clinical staging system based on the tumor grade, size, and presence of skip lesions or distant metastases and the histologic response to neoadjuvant chemotherapy have been reported to be the most important predictors of survival. […] The results of this study suggest that a fixed SUV threshold of 2.0 is suitable for measuring MTV, which reflects the biologically active tumor burden in patients with osteosarcoma.
#32 Initial Metabolic Tumor Volume Measured by 18F-FDG PET/CT Can Predict the Outcome of Osteosarcoma of the Extremities | Journal of Nuclear Medicine
https://jnm.snmjournals.org/content/54/10/1725
Stratification of patients by the combined criteria of MTV and histologic response could provide more detailed prediction of clinical outcome than MTV or histologic response alone. […] The MTV before neoadjuvant chemotherapy can accurately predict the clinical outcomes of patients with osteosarcoma. The combination of MTV and histologic response predicts survival more accurately than the histologic response alone.
#33 Bone Cancer: Survival Rates and Statistics | American Cancer Society
https://www.cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/survival-statistics.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time (usually 5 years) after they were diagnosed. […] Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and might raise more questions for you. Ask your doctor how these numbers might apply to you. […] These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] These numbers dont take everything into account. Survival rates are grouped based on the type of bone cancer and how far the cancer has spread. But other factors, such as your age and overall health, which bone the cancer started in, and how well the cancer responds to treatment, can also affect your outlook. […] People now being diagnosed with bone cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least 5 years earlier.
#34 Bone Cancer: Survival Rates and Statistics | American Cancer Society
https://www.cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/survival-statistics.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time (usually 5 years) after they were diagnosed. […] Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and might raise more questions for you. Ask your doctor how these numbers might apply to you. […] These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] These numbers dont take everything into account. Survival rates are grouped based on the type of bone cancer and how far the cancer has spread. But other factors, such as your age and overall health, which bone the cancer started in, and how well the cancer responds to treatment, can also affect your outlook. […] People now being diagnosed with bone cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least 5 years earlier.
#35 Bone Cancer: Survival Rates and Statistics | American Cancer Society
https://www.cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/survival-statistics.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time (usually 5 years) after they were diagnosed. […] Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and might raise more questions for you. Ask your doctor how these numbers might apply to you. […] These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] These numbers dont take everything into account. Survival rates are grouped based on the type of bone cancer and how far the cancer has spread. But other factors, such as your age and overall health, which bone the cancer started in, and how well the cancer responds to treatment, can also affect your outlook. […] People now being diagnosed with bone cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least 5 years earlier.
#36 Bone Cancer: Survival Rates and Statistics | American Cancer Society
https://www.cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/survival-statistics.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time (usually 5 years) after they were diagnosed. […] Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and might raise more questions for you. Ask your doctor how these numbers might apply to you. […] These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] These numbers dont take everything into account. Survival rates are grouped based on the type of bone cancer and how far the cancer has spread. But other factors, such as your age and overall health, which bone the cancer started in, and how well the cancer responds to treatment, can also affect your outlook. […] People now being diagnosed with bone cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least 5 years earlier.
#37 Bone Cancer: Survival Rates and Statistics | American Cancer Society
https://www.cancer.org/cancer/types/bone-cancer/detection-diagnosis-staging/survival-statistics.html
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain length of time (usually 5 years) after they were diagnosed. […] Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and might raise more questions for you. Ask your doctor how these numbers might apply to you. […] These numbers apply only to the stage of the cancer when it is first diagnosed. They do not apply later on if the cancer grows, spreads, or comes back after treatment. […] These numbers dont take everything into account. Survival rates are grouped based on the type of bone cancer and how far the cancer has spread. But other factors, such as your age and overall health, which bone the cancer started in, and how well the cancer responds to treatment, can also affect your outlook. […] People now being diagnosed with bone cancer may have a better outlook than these numbers show. Treatments improve over time, and these numbers are based on people who were diagnosed and treated at least 5 years earlier.
#38 Bone Cancer: Symptoms, Treatment & Outlook
https://my.clevelandclinic.org/health/diseases/17745-bone-cancer
Bone cancers are serious and require prompt treatment. The good news is that there are things healthcare providers can do to treat bone cancers and, in some cases, even cure them. […] Treatment for bone cancers is often successful. In many instances, the cancer never returns. You may need one or more surgeries to accomplish this outcome. […] Ultimately, every case is different, and there isnt one outcome that applies to everyone with a bone cancer. Your healthcare provider can explain your prognosis (outlook) based on the type of cancer, its stage, location and response to treatment. […] Though bone cancers can be fatal, many people make a full recovery. The five-year relative survival rate for bone cancer is 68.2%. This means that 68.2% of people with bone cancer are still alive five years after their diagnosis. Those with lower-stage bone cancers have a better chance of a full recovery. For people with higher-stage bone cancers, where its already spread, the chances of the cancer coming back increase.
#39 Primary Bone Cancer: Your Chances for Recovery (Prognosis) | Saint Luke’s Health System
https://www.saintlukeskc.org/health-library/primary-bone-cancer-your-chances-recovery-prognosis
Prognosis is the word your healthcare team may use to describe your likely outcome from cancer and cancer treatment. […] A healthcare provider who is most familiar with your health is in the best position to discuss your prognosis with you and explain what the statistics may mean in your case. […] Cancer and cancer treatment outcomes are hard to predict. […] If your cancer is likely to respond well to treatment, your healthcare provider will say you have a favorable prognosis. This means you’re expected to live many years and may even be cured. If your cancer is likely to be hard to control, your prognosis may be less favorable. The cancer may shorten your life. […] It is not a prediction of what will definitely happen. No healthcare provider can be fully sure about an outcome. […] The chance of recovery for bone cancers has improved in recent years because of new and better treatments.
#40 Bone Cancer: Symptoms, Treatment & Outlook
https://my.clevelandclinic.org/health/diseases/17745-bone-cancer
Bone cancers are serious and require prompt treatment. The good news is that there are things healthcare providers can do to treat bone cancers and, in some cases, even cure them. […] Treatment for bone cancers is often successful. In many instances, the cancer never returns. You may need one or more surgeries to accomplish this outcome. […] Ultimately, every case is different, and there isnt one outcome that applies to everyone with a bone cancer. Your healthcare provider can explain your prognosis (outlook) based on the type of cancer, its stage, location and response to treatment. […] Though bone cancers can be fatal, many people make a full recovery. The five-year relative survival rate for bone cancer is 68.2%. This means that 68.2% of people with bone cancer are still alive five years after their diagnosis. Those with lower-stage bone cancers have a better chance of a full recovery. For people with higher-stage bone cancers, where its already spread, the chances of the cancer coming back increase.
#41 Bone Cancer: Symptoms, Treatment & Outlook
https://my.clevelandclinic.org/health/diseases/17745-bone-cancer
Bone cancers are serious and require prompt treatment. The good news is that there are things healthcare providers can do to treat bone cancers and, in some cases, even cure them. […] Treatment for bone cancers is often successful. In many instances, the cancer never returns. You may need one or more surgeries to accomplish this outcome. […] Ultimately, every case is different, and there isnt one outcome that applies to everyone with a bone cancer. Your healthcare provider can explain your prognosis (outlook) based on the type of cancer, its stage, location and response to treatment. […] Though bone cancers can be fatal, many people make a full recovery. The five-year relative survival rate for bone cancer is 68.2%. This means that 68.2% of people with bone cancer are still alive five years after their diagnosis. Those with lower-stage bone cancers have a better chance of a full recovery. For people with higher-stage bone cancers, where its already spread, the chances of the cancer coming back increase.