Comment on “Predicting metastasis at initial diagnosis and radiotherapy effectiveness in patients with metastatic osteosarcoma”

To the Editor,

We read the recent study (Chen et al. 2023) on predicting metastasis at the initial diagnosis and assessing the effectiveness of radiotherapy in patients with metastatic osteosarcoma with great interest. The study's findings provide valuable insights into managing this aggressive form of bone cancer and have the potential to significantly impact patient care. The researchers aimed to develop a predictive model, known as the Nomogram, to determine the likelihood of metastasis in osteosarcoma patients at the time of diagnosis. The Nomogram has the potential to support physicians in making well-informed decisions regarding treatment strategies and post-diagnosis surveillance. Furthermore, the study explored the effectiveness of radiotherapy in metastatic osteosarcoma patients, offering valuable guidance to healthcare professionals in determining the most suitable treatment approach for individual patients. This has the potential to improve treatment outcomes and minimize treatment-related side effects. However, further attention should be given to addressing the following concerns.

Firstly, the study (Chen et al. 2023) lacks information on tumor size, which has been shown in previous research to be closely associated with lung metastasis in osteosarcoma. A study (Huang et al. 2019) involving 1057 osteosarcoma patients demonstrated that having a tumor size larger than 5–10 cm significantly increased the risk of lung metastasis as compared to patients with tumors smaller than 5 cm (HR = 2.046, 95% CI 1.153–3.632). Furthermore, the same study found that patients with tumors larger than 10 cm had an even higher risk of developing lung metastasis (HR = 3.610, 95% CI 2.066–6.310). Another study (Miller et al. 2013), based on the Surveillance, Epidemiology, and End Results (SEER) database, also indicated a significant correlation between larger tumor size and the risk of metastasis in osteosarcoma patients. When considering the above evidence, it is essential to recognize the significance of tumor size in predicting metastasis in osteosarcoma. Incorporating tumor size as a factor in future predictive models and research endeavors could enhance the accuracy and reliability of prognostic assessments.

Secondly, the study mentioned that the participants underwent surgery; however, the specific details of the surgical procedures are not clearly stated. It is important to consider the impact of surgical margins on local recurrence rates in osteosarcoma patients. An analysis of multiple studies (He et al. 2016), encompassing a total of 1559 patients, demonstrated that osteosarcoma resections with inadequate and marginal margins, regardless of whether the tumors were located in the extremities or the pelvis, were linked to substantially higher rates of local recurrence as compared to resections with adequate and wide margins, respectively. In a separate study (Bertrand et al. 2016), it was found that patients with high-grade osteosarcoma in the extremities, without metastasis, who had positive surgical margins, had a greater likelihood of experiencing local recurrence when compared with those with negative surgical margins. Thus, it is crucial to consider the impact of surgical margins on local recurrence rates in osteosarcoma. The omission of detailed information regarding surgical procedures in the study limits our ability to fully understand the potential influence of surgical margins on treatment outcomes. Future research should aim to incorporate comprehensive data on the surgical interventions, including margin status, to provide a more comprehensive assessment of treatment efficacy and local recurrence rates in osteosarcoma patients.

Thirdly, the study findings suggest that radiotherapy significantly improves the prognosis of osteosarcoma patients. Nevertheless, important aspects of radiotherapy, such as the timing (preoperative or postoperative), and the purpose (palliative or non-palliative), remain unclear. These details are crucial for clinicians when making treatment decisions and tailoring therapeutic approaches to individual patients. Understanding whether the radiotherapy was administered before or after surgery can provide valuable insights into its potential impact on tumor shrinkage, local control, and overall treatment outcomes. Furthermore, distinguishing between palliative and non-palliative radiotherapy can help determine the treatment intent and the goals of therapy, which are important factors in managing osteosarcoma patients with metastasis. Without this essential information, clinicians may face challenges in selecting the most appropriate treatment strategies for their patients. Clear and comprehensive reporting of radiotherapy details, including the timing, purpose, dose, and treatment fields, would greatly enhance the clinical relevance and applicability of the study findings.

Author contributions

The study was conceived, designed and wrote by GL and CC. SH and QH provide useful feedback to improve this manuscript.The final version of the manuscript received approval from all authors.

Data availability

No data used in this letter.

Declarations

Conflict of interest

The authors have no conflicts of interest relevant to this article.