Three Hematological Indexes That May Serve As Prognostic Indicators In Patients With Primary,High-grade,appendicular Osteosarcoma

Objective:Although alkaline phosphatase(ALP)and lactate dehydrogenase(LDH)are currently considered to be effective prognostic factors of osteosarcoma,useful prognostic biomarkers for patients with osteosarcoma are still lacking for further identifying personal prognosis.Fibrinogen(FBG)has been proposed to predict clinical outcomes in many types of cancers,however,its influence on prognosis of osteosarcoma patients is still lacking in evidence.Methods:A retrospective cohort study of 106 patients with primary,high-grade,appendicular osteosarcoma obtained between December,2006 and December,2011 was performed to assess the prognostic significance of ALP,LDH and FBG in osteosarcoma both before and after neo-adjuvant chemotherapy,as well as their decrease rates.Receiver Operating Characteristic curve(ROC curve)was performed to set the critical point of the indexes for survival,and patients were divided into two groups by the critical point.The relationship between hematological indexes and clinicopathological factors such as age,gender,metastasis,and pathological fracture were analyzed to test comparability between groups.Kaplan-Meier survival analysis were used to assess the impact of hematological indexes on survival of patients with osteosarcoma.The Cox proportional hazard model was utilized to determine the independent effect of these factors on patient survival.Results:Primary,high-grade,appendicular osteosarcoma patients with pre-ct(before neoadjuvant chemotherapy)LDH>210U/L,post-ct(after neoadjuvant chemotherapy,but before surgery)LDH>215U/L,post-ct FBG>2.8g/L,FBG DR(Decrease Rate)?10%tended to have a poorer prognosis(p<0.05).The Cox proportional hazard model further confirmed the results.Conclusions:High pre-ct and post-ct peripheral serum LDH level,high serum post-ct FBG level and low decrease rate of serum FBG were related to poor survival in patients with primary,high-grade,appendicular osteosarcoma.Fibrinogen was found to be a new valuable predictor of 5-year survival for those patients.