PURPOSE: Most aspects of osteosarcoma have been addressed in detail, but there is no comprehensive analysis of deceased patients and causes of death. METHODS: The database of the Cooperative Osteosarcoma Study Group COSS (1980-03/31/2021; 4475 registered high-grade central osteosarcoma patients) was searched deaths from any cause. Affected patients were analyzed for demographic and baseline variables and disease-status at the time of demise. Deaths from causes other than osteosarcoma were analyzed in detail. RESULTS: A total of 1520 deceased patients were identified (median age (range) at osteosarcoma diagnosis 16 (2-78) years; 908 (59.7%) male, 612 (40.3%) female; primary tumor: extremities 1263 (83.1%), trunk 208 (13.7%), craniofacial 47 (3.1%) (site unknown 2); metastases at registration: absent 1.051 (69.1%), present 466 (30.7%) (3 no data). The median time from diagnosis to death was 2.22 (0.08-32.02) years. 1286 (84.6%) patients succumbed to osteosarcoma (370 without achieving complete remission, 488 first, 428 more than one recurrences), 146 (9.6%) to other, 88 (5.8%) to unknown causes. Chemotherapy-related infections (40), secondary malignancies (39), and perioperative complications (19) were among the most frequent potentially treatment-related causes, and high-dose methotrexate (19), doxorubicin (17), and ifosfamide (15) were the drugs most commonly held responsible. Patients with unknown causes of death had an unusually long median follow-up. CONCLUSION: The major cause of death of patients after osteosarcoma is this malignancy, mostly from one of its multiple relapses. However, almost 10% of fatalities are due to other documented causes. Some of these deaths may be preventable with the knowledge gained from comprehensive analyses such as this.

Abteilung für Pädiatrische Onkologie Hämatologie Universitäts Kinderspital beider Basel Basel Switzerland

Cooperative Osteosarcoma Study Group Pädiatrie 5 Zentum für Kinder Jugend und Frauenmedizin Stuttgart Cancer Center Klinikum Stuttgart Olgahospital Stuttgart Germany

Cooperative Osteosarcoma Study Group Pädiatrie 5 Zentum für Kinder Jugend und Frauenmedizin Stuttgart Cancer Center Klinikum Stuttgart Olgahospital Stuttgart Germany; Klinik für Kinder und Jugendmedizin Pädiatrische Hämatologie und Onkologie Universitätsklinikum Münster Münster Germany

Innere Medizin 3 Sektion Onkologie Universitätsklinikum Ulm Ulm Germany

Kinder und Jugendklinik Pädiatrische Onkologie und Hämatologie Universitätsklinikum Erlangen Erlangen Germany

Kinderklinik Klinik für Pädiatrische Onkologie u Hämatologie Universitätsklinikum Düsseldorf Düsseldorf Germany

Kinderklinik München Schwabing Department of Pediatrics and Children's Cancer Research Center TUM School of Medicine Technische Universität München Munich Germany

Klinik für Innere Medizin A Hämatologie Hämostaseologie Onkologie und Pneumologie Universitätsklinikum Münster Münster Germany

Klinik für Kinder und Jugendmedizin Pädiatrische Hämatologie und Onkologie Universitätsklinikum Münster Münster Germany

Klinik für Kinder und Jugendmedizin Schwerpunkt Onkologie Hämatologie und Hämostaseologie Universitätsklinikum Frankfurt Frankfurt am Main Germany

Klinika Dětské Hematologie a Onkologie UK 2 LF a FN Motol Prague Czech Republic

Onkologie und Palliativmedizin Helios Klinikum Berlin Buch Berlin Germany

Pädiatrische Hämatologie und Onkologie Medizinische Hochschule Hannover Hannover Germany

Pädiatrische Hämatologie und Onkologie Universitätsklinikum Hamburg Eppendorf Hamburg Germany

Semmelweis Egyetem Budapest Hungary

St Anna Kinderspital Universitätsklinik für Kinder und Jugendheilkunde der Medizinischen Universität Wien and St Anna Children's Cancer Research Institute Vienna Austria

Universitätsklinik für Orthopädie und Unfallchirurgie Klinische Abteilung für Orthopädie Medizinische Universität Wien Vienna Austria

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