Postoperative Infection and Survival in Osteosarcoma Patients

The clinical impact of postoperative deep infection on survival remains controversial in osteosarcoma patients. The authors identified 31 osteosarcoma patients that developed a deep infection within 1 year of operation between 1990 and 2003, and compared clinicopathologic characteristics of 31 patients that developed an infection with those of 316 patients that did not. For survival analysis, 62 noninfected patients matched for prognostic factors such as histologic response, tumor size, and location were also selected. In infected patients, although it was not significant due to the small patient numbers, good response to preoperative chemotherapy and a proximal tibial location were frequently observed. No local recurrence developed in infected patients. Five-year overall and metastasis-free survival rates for the 31 infected patients were as high as 89% and 73%, respectively. However, after matching for clinical factors, no survival difference was noted between infected and noninfected patients. Deep infection has a multifaceted effect on patients. However, the present study suggests that the reported positive effect on survival is likely to be related to the clinical characteristics of infected patients rather than an antitumor effect due to the infection. Further investigations are needed to clarify the precise effects of infection.