Can we quantify a safe margin to reduce local recurrence in parosteal osteosarcomas around the distal femur? A cohort study based on 27 patients
DOI:
https://doi.org/10.2340/17453674.2026.45943Keywords:
Bone tumours, Local recurrence, Local recurrence free survival, Margins, MetastasisAbstract
Background and purpose: Parosteal osteosarcoma of the distal femur usually presents as a posteriorly outgrowing tumor that lies close to the popliteal neurovascular bundle, making resection with a wide margin difficult. Tumors are often lower grade meaning surgery often forms the mainstay of treatment. We aimed to evaluate resection margins on local recurrence (LR) and metastasis-free survival rates of patients undergoing surgery for parosteal osteosarcoma of the distal femur.
Methods: This retrospective study evaluated patients with histologically confirmed parosteal osteosarcoma of the distal femur at a single institution between 2000 and 2022, with at least 2 years of follow-up. Patients undergoing primary amputation, those with distant metastases at diagnosis, and those with insufficient clinical information were excluded from the study. Data such as postoperative margins, tumor grade, LR, and metastasis was collected and analyzed.
Results: 27 patients were included. Involved margin at resection was recorded in 4 patients: a closest margin of < 1 mm in 14 and ≥ 1 mm in 9. Local recurrence (LR) occurred in 8 patients. Compared with ≥ 1 mm margins, the risk of LR was higher for involved margins (risk difference [RD] 0.75, 95% confidence interval [CI] 0.21–0.95; relative risk [RR] 14.0, CI 0.88–222) and for < 1 mm margins (RD 0.36, CI 0.00–0.61; RR 7.33, CI 0.45–119). Metastasis-free survival showed similar trends. Compared with ≥ 1 mm margins, the risk of metastasis was higher for involved margins (RD 0.25, CI −0.11 to 0.70; RR 6.0, CI 0.29–122) and for < 1 mm margins (RD 0.36, CI 0.00–0.61; RR 7.33, CI 0.45–119). There was no significant difference between the tumor grade and rate of LR.
Conclusion: A margin greater than or equal to 1 mm showed reduced LR and less metastasis in patients with parosteal osteosarcoma of the distal femur.
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Prabowo Y, Kamal A F, Kodrat E, Prasetyo M, Maruanaya S, Efar T S. Parosteal osteosarcoma: a benign-looking tumour, amenable to a variety of surgical reconstruction. Int J Surg Oncol 2020; 2020: 4807612. doi: 10.1155/2020/4807612. DOI: https://doi.org/10.1155/2020/4807612
Laitinen M, Parry M, Albergo J I, Jeys L, Abudu A, Carter S, et al. The prognostic and therapeutic factors which influence the oncological outcome of parosteal osteosarcoma. Bone Joint J 2015; 97-B(12): 1698-703. doi: 10.1302/0301-620X.97B12.35749. DOI: https://doi.org/10.1302/0301-620X.97B12.35749
Ruengwanichayakun P, Gambarotti M, Frisoni T, Gibertoni D, Guaraldi F, Sbaraglia M, et al. Parosteal osteosarcoma: a monocentric retrospective analysis of 195 patients. Hum Pathol 2019; 91:11–18. doi: 10.1016/j.humpath.2019.05.009. DOI: https://doi.org/10.1016/j.humpath.2019.05.009
Funovics P T, Bucher F, Toma C D, Kotz R I, Dominkus M. Treatment and outcome of parosteal osteosarcoma: biological versus endoprosthetic reconstruction. J Surg Oncol 2011; 103(8): 782-9. doi: 10.1002/jso.21859. DOI: https://doi.org/10.1002/jso.21859
Savvidou O D, Goumenos S, Trikoupis I, Kaspiris A, Melissaridou D, Gavriil P, et al. Oncological and functional outcomes after hemicortical resection and biological reconstruction using allograft for parosteal osteosarcoma of the distal femur. Sarcoma 2022; 2022: 5153924. doi: 10.1155/2022/5153924. DOI: https://doi.org/10.1155/2022/5153924
Pezzillo F, Maccauro G, Nizegorodcew T, Rossi B, Gosheger G. Resection of parosteal osteosarcoma of the distal part of the femur: an original reconstruction technique with cement and plate. Sarcoma 2008; 2008: 763056. doi: 10.1155/2008/763056. DOI: https://doi.org/10.1155/2008/763056
Pacheco M, Guzmán R, Bonilla P. Dedifferentiated low-grade osteosarcoma, outcome with or without chemotherapy: a systematic review. Orthop Res Rev 2023; 15: 79-89. doi: 10.2147/ORR.S404475. DOI: https://doi.org/10.2147/ORR.S404146
Tsukamoto S, Righi A, Mavrogenis A F, Masunaga T, Honoki K, Fujii H, et al. Effect of adjuvant chemotherapy on localized dedifferentiated low-grade osteosarcoma: a systematic review. Musculoskelet Surg 2024; 108(3): 241-9. doi: 10.1007/s12306-023-00795-4. DOI: https://doi.org/10.1007/s12306-024-00821-5
Christensen R, Ranstam J, Overgaard S, Wagner P. Guidelines for a structured manuscript: statistical methods and reporting in biomedical research journals. Acta Orthop 2023; 94: 243-9. doi: 10.2340/17453674.2023.11974. DOI: https://doi.org/10.2340/17453674.2023.11656
Jeys L M, Thorne C J, Parry M, Gaston C L L, Sumathi V P, Grimer J R. A novel system for the surgical staging of primary high-grade osteosarcoma: the Birmingham classification. Clin Orthop Relat Res 2017; 475(3): 842-50. doi: 10.1007/s11999-016-5099-4. DOI: https://doi.org/10.1007/s11999-016-4851-y
Ding Y, Cai Y bo, Zhang Q. [Parosteal osteosarcoma: a clinical study of 48 cases]. Zhonghua Wai Ke Za Zhi 2003; 41(11): 832-6. PMID: 14703459.
Kawaguchi N, Ahmed A R, Matsumoto S, Manabe J, Matsushita Y. The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res 2004; (419): 165-72. doi: 10.1097/00003086-200402000-00027 DOI: https://doi.org/10.1097/00003086-200402000-00027
Jamshidi K, Mirzaei A, Bagherifard A, Jahansouz A, Mohaghegh M R. Does the adherence of distal femur parosteal osteosarcoma to the neurovascular bundle increase the rate of local recurrences? Orthop Traumatol Surg Res 2022; 108(4): 103220. doi: 10.1016/j.otsr.2022.103220. DOI: https://doi.org/10.1016/j.otsr.2022.103220
Song W S, Jeon D G, Cho W H, Kong C B, Cho S H, Lee K R, et al. Clinical outcome of parosteal osteosarcoma. J Korean Bone Joint Tumor Soc 2013; 19(1): 20-7. doi: 10.5292/jkbjts.2013.19.1.20. DOI: https://doi.org/10.5292/jkbjts.2013.19.1.20
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Copyright (c) 2026 Kumaran Rasappan, Giuseppe Francesco Papalia, Scott Evans, Micheal Parry, Jonathan Stevenson, Guy Morris, Lee Jeys, Vineet Kurisunkal
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