{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:03:11Z","timestamp":1789732991532,"version":"4.0.1"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["24K02566"],"award-info":[{"award-number":["24K02566"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K22659"],"award-info":[{"award-number":["25K22659"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Science"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Real\u2010world achievement of guideline\u2010concordant treatment in osteosarcoma remains unclear. This study aimed to determine stage\u2010specific rates of guideline\u2010concordant treatment, evaluate their association with survival outcomes, and identify factors associated with non\u2010concordance. Patients with osteosarcoma between 2011 and 2020 were identified from the Japanese Bone and Soft Tissue Tumor Registry. Rates of guideline\u2010concordant treatment and disease\u2010specific survival (DSS) were investigated. Among 1149 patients, 969 (84%) received guideline\u2010concordant treatment. Achievement rates were 85% for localized low\u2010grade, 83% for localized high\u2010grade, and 90% for metastatic osteosarcoma. In localized low\u2010grade disease, guideline\u2010concordant treatment was associated with superior 5\u2010year DSS (97% vs. 68%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.007); trunk location was associated with non\u2010concordance. In localized high\u2010grade disease, guideline\u2010concordant treatment was also associated with superior 5\u2010year DSS (78% vs. 50%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001); age\u2009&gt;\u200940\u2009years and trunk location were associated with non\u2010concordance. The association between guideline\u2010concordant treatment and superior DSS was observed in both patients \u2264\u200940\u2009years (82% vs. 50%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and\u2009&gt;\u200940\u2009years (61% vs. 50%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.030). However, in a sensitivity analysis restricted to localized high\u2010grade extremity osteosarcoma, this association remained significant among patients aged \u2264\u200940\u2009years. In metastatic disease, guideline\u2010concordant treatment was associated with superior 2\u2010year DSS (54% vs. 16%;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Overall, guideline\u2010concordant treatment was associated with superior survival outcomes in osteosarcoma. Treatment feasibility appeared to substantially influence treatment achievement and survival, particularly among older patients. No significant geographic disparities in achievement rates were observed across Japan, indicating a high and uniform standard of care nationwide. Wide\/radical surgical resection and perioperative chemotherapy remain crucial whenever clinically feasible.\n                  <\/jats:p>","DOI":"10.1111\/cas.70525","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T11:21:03Z","timestamp":1789730463000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Achievement of Guideline\u2010Concordant Treatment and Survival in Osteosarcoma: A Nationwide Registry Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4257-9180","authenticated-orcid":false,"given":"Tomohiro","family":"Fujiwara","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2116-586X","authenticated-orcid":false,"given":"Akira","family":"Kawai","sequence":"additional","affiliation":[{"name":"Division of Musculoskeletal Oncology National Cancer Centre Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshifumi","family":"Ozaki","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.07.018"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2001.19.11.2886"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1993.00410230060008"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.39.6937"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2012.00496.x"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2017.0017"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdy310"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jos.2023.11.007"},{"key":"e_1_2_13_10_1","volume-title":"Clinical Practice Guidelines for Pediatric Cancer 2016","author":"Hematology\/Oncology(JSPHO) 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