Osseous invasion in extremity soft-tissue sarcomas: prevalence, diagnosis, and surgical management- A narrative review

IF 3.5 2区医学 Q2 Medicine

Journal of Bone Oncology Pub Date : 2025-09-13 DOI:10.1016/j.jbo.2025.100712

Seyyed Saeed Khabiri , Khalil Kargar Shooroki , Sadegh Saberi , Hamed Naghizadeh

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引用次数: 0

Abstract

Background

Osseous invasion in extremity soft-tissue sarcomas (STS) occurs in approximately 5–11% of cases and is associated with larger tumor size, higher histologic grade, deeper location, and increased risk of metastasis. Despite its relative rarity, bone invasion is a critical prognostic factor, presenting unique diagnostic and surgical challenges.

Purpose

This review aimed to synthesize current evidence on the prevalence, diagnostic imaging, surgical management, and prognostic impact of osseous invasion in extremity STS and to offer evidence-based recommendations for clinical practice.

Methods

A comprehensive narrative review was conducted using structured searches of PubMed, Embase, and Cochrane Library, focusing on studies reporting original data on extremity STS with bone involvement. The key outcomes included diagnostic accuracy, surgical margins, functional recovery, and survival rates.

Results

Bone invasion significantly predicted poorer overall and disease-free survival, with 5-year survival rates of 27–40% compared to 60–70% in non-invasive cases. MRI remains the imaging modality of choice, although standardized radiological criteria for bone invasion are lacking. En-bloc resection provides reliable local control but carries substantial morbidity. Emerging bone-sparing techniques, such as subperiosteal and hemicortical resections, have demonstrated comparable oncologic outcomes with superior functional results in selected patients.

Conclusions

Bone invasion in extremity STS represents a high-risk tumor subset that warrants individualized multidisciplinary management. While wide resection remains the standard treatment in cases with medullary involvement, selected patients may benefit from function-preserving approaches without compromising oncologic safety. Future research should focus on standardizing the diagnostic criteria, validating conservative surgical strategies, and refining multimodal treatment protocols to optimize outcomes.

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四肢软组织肉瘤的骨侵犯：患病率，诊断和手术治疗-叙述回顾

背景：肢体软组织肉瘤（STS）的肿瘤侵袭发生率约为5-11%，与较大的肿瘤大小、较高的组织学分级、较深的位置和转移风险增加有关。尽管其相对罕见，骨侵犯是一个关键的预后因素，提出独特的诊断和手术挑战。目的本综述旨在综合目前关于四肢STS骨侵犯的患病率、诊断影像学、手术治疗和预后影响的证据，并为临床实践提供循证建议。方法采用PubMed、Embase和Cochrane图书馆的结构化检索进行综合叙述性综述，重点研究报告四肢STS伴骨受累的原始数据。主要结果包括诊断准确性、手术切缘、功能恢复和生存率。结果骨侵袭显著预示着较差的总生存率和无病生存率，5年生存率为27-40%，而非侵袭性病例为60-70%。MRI仍然是首选的成像方式，尽管缺乏标准化的骨侵犯放射学标准。整体切除提供了可靠的局部控制，但也带来了大量的发病率。新兴的保骨技术，如骨膜下切除术和半皮质切除术，已经在选定的患者中证明了可比较的肿瘤预后和优越的功能结果。结论四肢STS的骨侵犯是一个高风险的肿瘤亚群，需要个性化的多学科治疗。虽然广泛切除仍然是髓质受累病例的标准治疗方法，但某些患者可能受益于功能保留方法而不影响肿瘤安全性。未来的研究应集中在标准化诊断标准，验证保守手术策略，完善多模式治疗方案以优化结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Bone Oncology ONCOLOGY-

CiteScore

7.20

自引率

2.90%

发文量

审稿时长

34 days

期刊介绍： The Journal of Bone Oncology is a peer-reviewed international journal aimed at presenting basic, translational and clinical high-quality research related to bone and cancer. As the first journal dedicated to cancer induced bone diseases, JBO welcomes original research articles, review articles, editorials and opinion pieces. Case reports will only be considered in exceptional circumstances and only when accompanied by a comprehensive review of the subject. The areas covered by the journal include: Bone metastases (pathophysiology, epidemiology, diagnostics, clinical features, prevention, treatment) Preclinical models of metastasis Bone microenvironment in cancer (stem cell, bone cell and cancer interactions) Bone targeted therapy (pharmacology, therapeutic targets, drug development, clinical trials, side-effects, outcome research, health economics) Cancer treatment induced bone loss (epidemiology, pathophysiology, prevention and management) Bone imaging (clinical and animal, skeletal interventional radiology) Bone biomarkers (clinical and translational applications) Radiotherapy and radio-isotopes Skeletal complications Bone pain (mechanisms and management) Orthopaedic cancer surgery Primary bone tumours Clinical guidelines Multidisciplinary care Keywords: bisphosphonate, bone, breast cancer, cancer, CTIBL, denosumab, metastasis, myeloma, osteoblast, osteoclast, osteooncology, osteo-oncology, prostate cancer, skeleton, tumour.