The aim of this study was to determine whether
the level of circulating C-reactive protein (CRP) before treatment predicted
overall disease-specific survival and local tumour control in patients
with a sarcoma of bone. We retrospectively reviewed 318 patients who presented with a
primary sarcoma of bone between 2003 and 2010. Those who presented
with metastases and/or local recurrence were excluded. Elevated CRP levels were seen in 84 patients before treatment;
these patients had a poorer disease-specific survival (57% at five
years) than patients with a normal CRP (79% at five years) (p <
0.0001). They were also less likely to be free of recurrence (71%
at five years) than patients with a normal CRP (79% at five years)
(p = 0.04). Multivariate analysis showed the pre-operative CRP level
to be an independent predictor of survival and local control. Patients
with a Ewing’s sarcoma or chondrosarcoma who had an elevated CRP
before their treatment started had a significantly poorer disease-specific
survival than patients with a normal CRP (p = 0.02 and p <
0.0001, respectively).
Patients with a conventional osteosarcoma and a raised CRP were
at an increased risk of poorer local control. We recommend that CRP levels are measured routinely in patients
with a suspected sarcoma of bone as a further prognostic indicator
of survival. Cite this article:
We retrospectively compared the outcome after
the treatment of giant cell tumours of bone either with curettage alone
or with adjuvant cementation. Between 1975 and 2008, 330 patients
with a giant cell tumour were treated primarily by intralesional
curettage, with 84 (25%) receiving adjuvant bone cement in the cavity.
The local recurrence rate for curettage alone was 29.7% (73 of 246)
compared with 14.3% (12 of 84) for curettage and cementation (p
= 0.001). On multivariate analysis both the stage of disease and
use of cement were independent significant factors associated with
local recurrence. The use of cement was associated with a higher
risk of the subsequent need for joint replacement. In patients without
local recurrence, 18.1% (13 of 72) of those with cement needed a
subsequent joint replacement compared to 2.3% (4 of 173) of those
without cement (p = 0.001). In patients who developed local recurrence,
75.0% (9 of 12) of those with previous cementation required a joint
replacement, compared with 45.2% (33 of 73) of those without cement
(p = 0.044).
