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Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis
Author(s) -
Newman Erik T.,
Rein Eveline A. J.,
Theyskens Nina,
Ferrone Marco L.,
Ready John E.,
Raskin Kevin A.,
Lozano Calderon Santiago A.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26205
Subject(s) - medicine , amputation , chondrosarcoma , cohort , surgery , sarcoma , retrospective cohort study , hazard ratio , proportional hazards model , calcaneus , cohort study , confidence interval , pathology
Background and Objectives Malignant tumors of the calcaneus are rare but pose a treatment challenge. Aims: (1) describe the demographics of calcaneal malignancies in a large cohort; (2) describe survival after amputation versus limb‐salvage surgery for high‐grade tumors. Methods Study group: a “pooled” cohort of patients with primary calcaneal malignancies treated at two cancer centers (1984−2015) and systematic literature review. Kaplan−Meier analyses described survival across treatment and diagnostic groups; proportional hazards modeling assessed mortality after amputation versus limb salvage. Results A total of 131 patients (11 treated at our centers and 120 patients from 53 published studies) with a median 36‐month follow‐up were included. Diagnoses included Ewing sarcoma (41%), osteosarcoma (30%), and chondrosarcoma (17%); 5‐year survival rates were 43%, 73% (70%, high grade only), and 84% (60%, high grade only), respectively. Treatment involved amputation in 52%, limb salvage in 27%, and no surgery in 21%. There was no difference in mortality following limb salvage surgery (vs. amputation) for high‐grade tumors (HR 0.38; 95% CI 0.14−1.05), after adjusting for Ewing sarcoma diagnosis (HR 5.15; 95% CI 1.55−17.14), metastatic disease at diagnosis (HR 3.88; 95% CI 1.29−11.64), and age (per‐year HR 1.04; 95% CI 1.02−1.07). Conclusions Limb salvage is oncologically‐feasible for calcaneal malignancies.