The prognostic significance of lymphovascular tumor invasion in localized high‐grade osteosarcoma: Outcomes of a single institution over 10 years

Backgrounds and Objectives Lymphovascular invasion (LVI) has shown evidence of an association with worse survival in high‐grade osteosarcoma patients. The purpose of this investigation was to prognosticate LVI as a predictor of survival. Methods This was a retrospective review of high‐grade, localized osteosarcoma patients over a consecutive 10‐year period. Proportional hazards regression was used to identify prognostic factors. Cumulative mortality incidence was estimated with recurrence as a competing risk. Results Forty‐two cases with a median follow‐up of 64 months (range, 6–158 months) were reviewed. LVI was present in 21.4% ( n  = 9) cases. The five‐ and ten‐year survivals in LVI (+) were 40% and 20%, compared to 93% and 81% in LVI (−), respectively ( p  < .001). After controlling for confounders, advanced age (hazards ratio [HR], 1.134; 95% confidence interval [CI], 1–1.2; p  = .01) and LVI (HR, 21.768; 95% CI, 3–135; p  = .001) were negative prognosticators. The cumulative incidence of recurrence was no different between LVI (+) and LVI (−) ( p  = .811), though the incidence of mortality was significantly higher in LVI (+) ( p  = .003). Conclusion The presence of LVI in the setting of high‐grade, localized osteosarcoma is associated with greater rates of mortality and appears to portend a dismal prognosis.