Amputation surgery associated with shortened survival in patients with localized extremity bone sarcoma.

ABSTRACT

Background: This study assesses survival rates among patients with localized extremity bone sarcoma who have undergone amputation, pinpointing subpopulations that are disproportionately affected by amputation-related survival disparities. Methods: Examination of data was conducted using the Surveillance, Epidemiology, and End Results (SEER) program, analyzing records of 3765 patients diagnosed with localized extremity bone sarcoma between 2000 and 2019. Of these, 857 received amputations (Amputation cohort), and 2908 underwent limb-sparing surgeries. Propensity score matching, considering demographic and clinical features, was utilized to ensure a fair comparison. Results: Following propensity score matching, the study focused on 1714 cases. The Amputation cohort was observed to have significantly poorer survival rates (Cancer-Specific Survival [CSS] Hazard Ratio [HR] = 1.28, 95% Confidence Interval [CI] 1.05-1.55; Overall Survival [OS] HR = 1.37, 95% CI 1.15-1.63). Subsequent subgroup analysis indicated that individuals with tumors exceeding 8 cm in size or those located in the lower limbs were notably at a higher risk of shortened survival (for tumors >8 cm - CSS HR = 1.32, 95% CI 1.02-1.71; OS HR = 1.39, 95% CI 1.09-1.76; for lower limb tumors - CSS HR = 1.25, 95% CI 1.01-1.54; OS HR = 1.33, 95% CI 1.11-1.61). Conclusions: Our findings demonstrate that patients diagnosed with localized extremity bone sarcoma undergoing amputation exhibit lower survival rates, especially in cases involving tumors of greater size or those situated in the lower limbs. In patient groups where amputation is inevitable, careful follow-up is required after surgical intervention.