[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-442867-105":59,"doc-detail-442867-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","time-to-treatment-initiation-and-overall-survival-in-osteosarcoma-a-national-cancer-database-analysis","Time to treatment initiation and overall survival in osteosarcoma - a national cancer database analysis","","Evaluating how time to treatment initiation (TTI)—the interval between definitive diagnosis and definitive therapy—relates to overall survival in high-grade, localized osteosarcoma. The National Cancer Database was queried for patients with histologically confirmed disease from January 2004 to December 2021, using Kaplan-Meier survival curves and Cox regression with clinically relevant covariates. TTI under four weeks showed higher overall survival in unadjusted analysis. Univariable models linked prolonged TTI to increased hazard, but multivariable results were not statistically significant, suggesting confounding by associated patient factors. Prompt treatment initiation remains a reasonable clinical goal to reduce avoidable delays.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/time-to-treatment-initiation-and-overall-survival-in-osteosarcoma-a-national-cancer-database-analysis/442867/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/time-to-treatment-initiation-and-overall-survival-in-osteosarcoma-a-national-cancer-database-analysis/442867.png","ImageObject",300,407,{"name":92,"@type":93},"LangkahRina","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is time to treatment initiation (TTI) in this study?","Question",{"text":112,"@type":113},"TTI is the interval between a definitive diagnosis and the start of definitive treatment. It is evaluated as a prognostic factor for overall survival in high-grade, localized osteosarcoma.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were the patients and variables analyzed?",{"text":117,"@type":113},"Patients with histologically confirmed high-grade, localized osteosarcoma were identified in the National Cancer Database (2004–2021). Survival was assessed with Kaplan-Meier curves and Cox regression controlling for clinically pertinent covariates.",{"name":119,"@type":110,"acceptedAnswer":120},"What did the study find about the relationship between TTI and survival?",{"text":121,"@type":113},"Overall survival was higher when TTI was less than four weeks in Kaplan-Meier analysis. Univariable Cox regression showed prolonged TTI was associated with worse survival, but this association was not statistically significant after multivariable adjustment.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},442867,1791005812,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},962090893776,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Time to treatment initiation and overall survival in osteosarcoma: a national cancer database analysis  \nFrom Albany Medical College, Albany, USA  \nCorrespondence should be sent to M. R. DiCaprio  \n[dicaprm@amc.edu](dicaprm@amc.edu)  \n[Cite this article:](Cite this article:)  \nBone Jt Open 2026;7(1): 9–18.  \nDOI: 10. 1302/2633-1462 .  \n71.BJO-2025-0315.R1  \nS. H. Farmer,1 A. C. O'Brien,1 P. J. Feustel,2 M. R. DiCaprio3  \n1Albany Medical College, Albany, USA  \n2Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, USA  \n3Department of Orthopaedic Surgery, Division of Orthopaedic Oncology, Albany Medical Center, Albany, USA  \nAims  \nPatients with rare diseases, such as osteosarcoma, often experience diagnostic delays, and clinicians have limited evidence-based guidelines to inform care. Time to treatment initiation (TTI), the interval between a definitive diagnosis and the start of a definitive treatment, has emerged as a prognostic factor for various cancer types. However, the relationship between TTI and survival outcomes has not been established in patients with high-grade, localized osteosarcoma. The aim of this study was to evaluate the impact of TTI on overall survival inpatients with this aggressive bone sarcoma.  \nMethods  \nThe National Cancer Database was queried from January 2004 to December 2021 to identify all patients with histologically confirmed high-grade, localized osteosarcoma. Survival analysis was conducted using Kaplan-Meier curves and Cox regression modelling controlling for clinically pertinent covariates.  \nResults  \nA total of 3,750 patients were included. Overall survival was significantly higher in the cohort that experienced TTI of less than four weeks in Kaplan-Meier analysis (p \u003C 0.001, log-rank test) . Univariable Cox regression conveyed a significant association between prolonged TTI and overall survival (hazard ratio (HR) 1.03 per week of delay; 95% CI 1.02 to 1.04; p \u003C 0.001) . However, there was no statistically significant relationship following multivariable Cox regression (HR 1.01; 95% CI 0.99 to 1.02; p = 0.284) .  \nConclusion  \nProlonged TTI was associated with increased mortality, although not independently. Multicollinearity between covariates and TTI complicates the interpretation, making it unclear whether TTI itself or related factors primarily influence survival. Nevertheless, prompt treatment initiation remains a reasonable clinical goal to help minimize avoidable delays and support coordinated, timely care.  \nTake home message  \n• This is the first study to evaluate the impact of time to treatment initiation (TTI) on survival in patients with high-grade, localized osteosarcoma.  \n• Although univariable results suggest a survival benefit with prompt treatment, TTI may serve as a proxy for underlying clinical or demographic factors rather than  \nindependently predicting survival, underscoring the need for further prospective investigation.  \nIntroduction  \nOsteosarcoma is the most common primary bone malignancy in the USA.1-3 The majority of osteosarcoma histologies are classic or conventional high-grade type and carry a  \nTime to treatment initiation and overall survival in osteosarcoma 9  \nS. H. Farmer, A. C. O'Brien, P. J. Feustel, M. R. DiCaprio  \nhigh propensity to metastasize.4,5 The overall five-year survival rate for localized osteosarcoma is 68%,6 but drops significantly to under 30% in patients with distant metastasis.7-9 Early diagnosis and treatment is a desire of clinicians aiming to improve overall survival and reduce the risk of metastasis in osteosarcoma patients.  \nReducing time to diagnosis has demonstrated mixed success in predicting survival outcomes.10-12 A significant drawback of using the symptom duration metric is its reliance on self-reported data, making it susceptible to recall bias. 13,14 In light of this drawback, time to treatment initiation (TTI), the period of time between a definitive diagnosis and definitive treatm","cbCaipo9XaTWvYeE","https://ap.wps.com/l/cbCaipo9XaTWvYeE","pdf",1029639,"English","# Aims\n# Methods\n## Database\n# Results\n# Conclusion\n# Take home message\n# Introduction","[{\"question\":\"What is time to treatment initiation (TTI) in this study?\",\"answer\":\"TTI is the interval between a definitive diagnosis and the start of definitive treatment. It is evaluated as a prognostic factor for overall survival in high-grade, localized osteosarcoma.\"},{\"question\":\"How were the patients and variables analyzed?\",\"answer\":\"Patients with histologically confirmed high-grade, localized osteosarcoma were identified in the National Cancer Database (2004–2021). Survival was assessed with Kaplan-Meier curves and Cox regression controlling for clinically pertinent covariates.\"},{\"question\":\"What did the study find about the relationship between TTI and survival?\",\"answer\":\"Overall survival was higher when TTI was less than four weeks in Kaplan-Meier analysis. Univariable Cox regression showed prolonged TTI was associated with worse survival, but this association was not statistically significant after multivariable adjustment.\"}]","Time to treatment initiation and overall survival in osteosarcoma - a national cancer database analysis | PDF",1790701911,25]