Mirabello, Cancer 2009 - Osteosarcoma Incidence and Survival Rates from 1973 to 2004: Data from the Surveillance, Epidemiology, and End Results Program - Article Summary

Osteosarcoma Incidence and Survival Rates from 1973 to 2004: Data from the Surveillance, Epidemiology, and End Results Program.

Mirabello, Savage, et al.·Cancer·2009·2,165 citations·Oncology

This population-based study analyzed 3,482 osteosarcoma cases from the NCI SEER database (1973-2004). It describes incidence and survival across all age groups, races, sexes, anatomic sites, and pathologic subtypes. The goal was to provide the first comprehensive, age-stratified epidemiologic description of this rare tumor.

Key Findings

Osteosarcoma follows a bimodal incidence pattern that every orthopedic surgeon must know:
- Ages 0-24: 4.4/million (adolescent peak)
- Ages 25-59: 1.7/million (plateau)
- Ages 60+: 4.2/million (second peak)
The lower long bones dominate in young patients, but anatomic site shifts dramatically with age:
- Ages 0-24:
  - lower long bones 74.5%,
  - upper long bones 11%
- Ages 25-59:
  - lower long bones 43%,
  - pelvic region 11%
- Ages 60+:
  - lower long bones 27%,
  - pelvic region 19%
- Pelvic location carries the worst prognosis at every age — 5-year survival as low as 4.4% in elderly patients.
Chemotherapy introduced in the early 1980s drove survival from ~20% to ~70%. But survival has not improved since 1984.
- Ages 0-24: 61.6% overall 5-year survival
- Ages 25-59: 58.7%
- Ages 60+: 24.2%, falling to 10.8% for ages 80-84
- This plateau signals a biological ceiling with current regimens and is the strongest argument for clinical trial enrollment.
In the elderly, Paget disease-associated and secondary (post-treatment) osteosarcomas account for only ~34% of cases. Not the majority, as older hospital-based series suggested.
- Primary osteosarcoma predominates even in patients over 60.
- Misdiagnosis likely inflated secondary-cause estimates in prior reports.
Incidence peaks at age 12 in females vs age 16 in males, correlating with earlier puberty onset.
- Under age 15, females actually have slightly higher incidence than males.
- The overall male predominance (1.22:1) emerges only in older strata.

Board PearlOsteosarcoma survival improved from 20% to 70% after 1980s chemotherapy but has not improved since 1984 — new strategies are urgently needed.

Mirabello, Cancer 2009 - Osteosarcoma Incidence and Survival Rates from 1973 to 2004: Data from the Surveillance, Epidemiology, and End Results Program

Osteosarcoma Incidence and Survival Rates from 1973 to 2004: Data from the Surveillance, Epidemiology, and End Results Program.

Key Findings

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