SynthesisWorld journal of surgical oncology2025
Comparative outcomes of neoadjuvant chemotherapy versus upfront surgical resection in osteosarcoma: a systematic review and meta-analysis.
Synthesis in World journal of surgical oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
3 citing papers in PubMed.
- Targeting SQLE-Mediated Cholesterol Metabolism to Promote Oxidative Stress and Attenuate Drug Resistance in Osteosarcoma.Antioxidants (Basel, Switzerland) · 2026Article
- Accordion Maneuver for Delayed Regenerate Formation Following Pediatric Osteosarcoma Resection: A Case Report and Literature Review.Reports (MDPI) · 2026Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOsteosarcoma is an aggressive primary bone tumor commonly managed with multimodal therapy; however, the optimal sequencing of chemotherapy and surgery remains debated. Neoadjuvant chemotherapy (NACT) is widely used to facilitate limb-salvage surgery (LSS) and assess histologic response, yet its comparative benefit over upfront surgical resection remains unclear. This systematic review and meta-analysis aimed to compare oncologic and surgical outcomes between NACT followed by surgery versus upfront surgical resection in patients with osteosarcoma.
methodsA systematic search of PubMed, CENTRAL, and Google Scholar was conducted up to June 2025. Eligible studies included patients with histologically confirmed osteosarcoma treated with NACT plus surgery or upfront surgical resection. The primary outcome was overall survival (OS); secondary outcomes included disease-free survival (DFS), local recurrence (LR), distant metastasis, surgical complications, and chemotherapy-related adverse effects. Random-effects meta-analyses reported risk ratios (RRs) with 95% CIs and prediction intervals; leave-one-out influence and Hartung-Knapp (HK) adjustments were performed. Certainty was appraised with GRADE.
resultsTwenty-five studies involving 4,867 patients were included; 14 studies qualified for meta-analysis. Pooled analysis showed no significant difference in OS (RR: 1.09; 95% CI: 0.95-1.24; p = 0.225) or DFS (RR: 1.18; 95% CI: 0.73-1.89) between groups. However, NACT significantly reduced LR risk (RR: 0.45; 95% CI: 0.25-0.79; p < 0.05) and was associated with higher LSS rates. GRADE certainty was low for OS/DFS and moderate for LR.
conclusionAlthough NACT did not improve survival versus upfront surgery, it was associated with reduced local recurrence and greater feasibility of limb-salvage, supporting its role within multimodal care, particularly when local control and limb preservation are priorities, and in complex or high-risk presentations.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.