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Background <p>Although parosteal osteosarcoma (POS) is generally considered indolent with favorable short-term outcomes, its long-term biological behavior remains poorly understood. This study investigated late-onset events and prognostic factors for POS through an extended follow-up.</p> Methods <p>We retrospectively analyzed 84 patients with histologically confirmed POS treated between 2000 and 2020 at our institution. All patients were followed up for a minimum of 5 years. A subgroup analysis was performed for patients followed for more than 10 years to assess very late (&gt; 10 years) local recurrence and distant metastases. Clinical, radiological, and pathological data were also analyzed. The secondary outcomes were survival rates and patterns of disease progression.</p> Results <p>At a mean follow-up of 10.33 years (range, 5–21 years), local recurrence occurred in 22.6% (19/84) of patients, with 47.37% (9/19) of cases occurring after 10 years. Distant metastases developed in 13.1% (11/84) of patients, with 45.45% (5/11) manifesting after 10 years. Dedifferentiation occurred in 7.1% (6/84) of patients at a median of 8.7 years post-treatment. Multivariate analysis revealed that a tumor size &gt; 8&#xa0;cm (HR: 3.53, <i>p</i> = 0.018), medullary involvement (HR: 2.52, <i>p</i> = 0.049), and hemicortical resection (HR: 2.94, <i>p</i> = 0.041) were independent predictors of late-stage recurrence. The overall survival rates at 5, 10, and 15 years were 95.2%, 91.7%, and 88.1%, respectively.</p> Conclusions <p>POS has significant potential for late recurrence and metastasis beyond the conventional follow-up periods. These findings support the need for extended surveillance, particularly in patients with identified risk factors, and suggest that current follow-up protocols may require revision to account for late-onset events.</p>

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Late-onset events in parosteal osteosarcoma: findings from a two-decade retrospective study

  • 期刊论文

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  • 发表日期：

    2026年5月30日

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  • Khodamorad Jamshidi,
  • Karo Khosravi,
  • Seyyed Saeed Khabiri

摘要

Background

Although parosteal osteosarcoma (POS) is generally considered indolent with favorable short-term outcomes, its long-term biological behavior remains poorly understood. This study investigated late-onset events and prognostic factors for POS through an extended follow-up.

Methods

We retrospectively analyzed 84 patients with histologically confirmed POS treated between 2000 and 2020 at our institution. All patients were followed up for a minimum of 5 years. A subgroup analysis was performed for patients followed for more than 10 years to assess very late (> 10 years) local recurrence and distant metastases. Clinical, radiological, and pathological data were also analyzed. The secondary outcomes were survival rates and patterns of disease progression.

Results

At a mean follow-up of 10.33 years (range, 5–21 years), local recurrence occurred in 22.6% (19/84) of patients, with 47.37% (9/19) of cases occurring after 10 years. Distant metastases developed in 13.1% (11/84) of patients, with 45.45% (5/11) manifesting after 10 years. Dedifferentiation occurred in 7.1% (6/84) of patients at a median of 8.7 years post-treatment. Multivariate analysis revealed that a tumor size > 8 cm (HR: 3.53, p = 0.018), medullary involvement (HR: 2.52, p = 0.049), and hemicortical resection (HR: 2.94, p = 0.041) were independent predictors of late-stage recurrence. The overall survival rates at 5, 10, and 15 years were 95.2%, 91.7%, and 88.1%, respectively.

Conclusions

POS has significant potential for late recurrence and metastasis beyond the conventional follow-up periods. These findings support the need for extended surveillance, particularly in patients with identified risk factors, and suggest that current follow-up protocols may require revision to account for late-onset events.