Research Article Prognostic Factors and Treatment Results of High-Grade Osteosarcoma in Norway: A Scope Beyond the ‘‘Classical’’ Patient Kjetil Berner, 1,2 Kirsten Sundby Hall, 1 Odd R. Monge, 3 Harald Weedon-Fekjær, 4 Olga Zaikova, 5 and Øyvind S. Bruland 1,6 1 Department of Oncology, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway 2 Te Norwegian Cancer Registry, 0304 Oslo, Norway 3 Department of Oncology, Haukeland University Hospital, 5020 Bergen, Norway 4 Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424 Oslo, Norway 5 Department of Orthopedics, Oslo University Hospital, Norwegian Radium Hospital, 0424 Oslo, Norway 6 Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway Correspondence should be addressed to Øyvind S. Bruland; oyvind.bruland@medisin.uio.no Received 26 September 2014; Accepted 12 January 2015 Academic Editor: Eugenie S. Kleinerman Copyright © 2015 Kjetil Berner et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. A retrospective study of prognostic factors and treatment outcome of osteosarcoma (OS) during modern chemotherapy era with focus on patients with primary metastatic disease, nonextremity localisation, or age >40 years (nonclassical OS). Methods. A nationwide cohort, comprising 424 high-grade Norwegian bone OS patients, was based on registry sources supplemented with clinical records from hospitals involved in sarcoma management between 1975 and 2009. Results. Only 48% were younger patients with tumour in the extremities and without metastasis at diagnosis (classical OS). A considerable discrepancy in survival between classical and nonclassical OS was observed: 61% versus 26% 10-year sarcoma specifc survival. Twice as many of the former received both adequate surgery and chemotherapy compared to the latter. Tis could only partly explain the diferences in survival due to inherent chemoresistance in primary metastatic disease and a higher rate of local relapse among patients with axial tumours. Metastasis at diagnosis, increased lactate dehydrogenase, age > 40 years, and tumour size above median value were all adverse prognostic factors for overall survival. Conclusion. We confrm a dramatic diference in outcome between classical and nonclassical high-grade OS patients, but treatment variables could only partly explain the dismal outcome of the latter. 1. Introduction Multimodal treatment including multiagent chemotherapy has been essential to improve the survival of high-grade osteosarcoma (OS) patients [1–7]. Te literature has predom- inantly focused on “classical OS” (COS); that is, extremity localized primary tumour, high-grade histology, age below 40 years, and no detectable metastasis at primary diagnosis. Te prognoses are dismal for other subgroups of OS, that is, the “nonclassical OS” (NCOS) [5, 8–10]. Patients with axial OS may die due to lack of local control, even without detectable metastases. Te chemoresistant disease in patients presenting with overt metastases is also an unsolved clinical challenge. Te poor tolerance to adequate chemotherapy in the elderly represents another hurdle. In this paper we report outcome of patients with NCOS during the modern chemotherapy era. Our cohort represents an unselected Norwegian OS population [10]. Te purpose of this study was to compare patients with COS and NCOS with respect to patient characteristics and prognostic factors related to treatment outcome. To our knowledge only a few nationwide studies have previously been published [10–17]. None of these have specifcally addressed a scope beyond the classical patient. Hindawi Publishing Corporation Sarcoma Volume 2015, Article ID 516843, 14 pages http://dx.doi.org/10.1155/2015/516843