Work

BMI-for-age Z-score is associated with prosthetic failure after endoprosthetic reconstruction in pediatric osteosarcoma

Year: 2026

Type: article

Abstract: Background Endoprosthetic reconstruction is a standard limb-salvage procedure for children and adolescents with osteosarcoma, but implant failure still limits long-term function. Body habitus influences outcome in adult arthroplasty, but the role of age-adjusted body mass index (BMI) in pediatric orthopaedic oncology remains unclear. We examined the association between BMI-for-age Z -scores and implant survival and whether it was nonlinear. Methods At a tertiary center, we conducted a retrospective review of 239 consecutive patients with osteosarcoma treated with tumor resection and endoprosthetic reconstruction. BMI was converted to World Health Organization BMI-for-age Z -scores and ranked as low, normal, or high. The primary endpoint was implant failure. Implant survival was assessed using Fine-Gray competing-risk models, with death as a competing event. The dose-response relationship was assessed using restricted cubic splines. The Fine-Gray regression was used to analyze postoperative complications with sensitivity analysis for lower-extremity reconstruction. Results Implant survival was lower in the low- and high-BMI groups than in the normal-BMI group. In Fine-Gray competing risk analysis, both low and high BMI were independently associated with implant failure (subdistribution hazard ratio [SHR] = 2.10, 95% confidence interval [CI]: 1.18–3.76; P = 0.012 and SHR = 2.28, 95% CI: 1.43–3.65; P = 0.001, respectively). Restricted cubic spline modeling revealed a significant U-shaped association between BMI-for-age Z -score and implant failure risk (nonlinear P = 0.022; overall association P = 0.001). Abnormal BMI was also associated with more postoperative complications, and this was consistent in the lower-extremity subgroup. Conclusions In pediatric osteosarcoma, the BMI-for-age Z-score was significantly associated with implant failure, with a higher risk at both low and high values, thus demonstrating a U-shaped relationship. This supports the use of age-adjusted nutritional assessment for preoperative risk stratification in pediatric limb-salvage reconstruction.

Source: Journal of bone oncology

DOI: 10.1016/j.jbo.2026.100812

Authors: Song Peng, Zhilong She, Jiahao Chen, Qiong Wu, Guangxin Zhou, Yicun Wang

Institutions: Nanjing Medical University, Nanjing General Hospital of Nanjing Military Command, Nanjing University

Language: English

Topic: Sarcoma Diagnosis and Treatment

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,990