Prognostic Factors in High Grade Osteosarcoma Patients Who Received Neoadjuvant Therapy and Subsequently Underwent Surgery: Data from the Turkish Oncology Group
<b>Background:</b> Osteosarcoma is a rare but aggressive bone malignancy. Despite advances in multimodal therapy, survival remains suboptimal, highlighting the need for prognostic markers to guide treatment. <b>Methods:</b> This study included 162 osteosarcoma patients who received neoadjuvant chemotherapy followed by surgery between January 2009 and March 2024. Patients received either double (cisplatin + doxorubicin) or triple (MAP or PEI) chemotherapy. Survival analyses were conducted using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. <b>Results:</b> The median age was 20 years (IQR: 18-29), and 53.1% were male. Patients who received triple chemotherapy regimens demonstrated significantly longer overall survival (OS) compared to those on doublet regimens. High tumor necrosis rates (>90%) and negative surgical margins were strongly associated with improved OS, while metastatic disease at diagnosis, elevated alkaline phosphatase (ALP), and male gender were linked to poorer survival. Multivariate analysis identified adjuvant therapy, age under 18, high necrosis rate, negative margins, and normal ALP as significant OS predictors. <b>Conclusions:</b> Triple-agent chemotherapy, necrosis rate ≥90 and negative surgical margins are strongly associated with prolonged survival in osteosarcoma. The key prognostic indicators such as ALP levels, surgical margins and age at diagnosis should guide personalized treatment strategies to improve outcomes in curable patients.
Authors
- İbrahim Vedat Bayoğlu (ORCID: https://orcid.org/0000-0002-0481-1084)
- Selver Işık (ORCID: https://orcid.org/0000-0002-2726-1740)
- Özlem Erçelep (ORCID: https://orcid.org/0000-0001-5892-3519)
- Nargız Majidova (ORCID: https://orcid.org/0000-0002-2575-5819)
- Emine Bihter Eniseler (ORCID: https://orcid.org/0000-0001-5638-1816)
- Pınar Erel (ORCID: https://orcid.org/0000-0002-2797-2075)
- Mustafa Şahbazlar (ORCID: https://orcid.org/0000-0003-1857-593X)
- Melih Şimşek (ORCID: https://orcid.org/0000-0003-0633-8558)
- Rukiye Arıkan (ORCID: https://orcid.org/0000-0003-2688-1515)
- Ali Kaan Güren (ORCID: https://orcid.org/0000-0002-3562-5006)
- Abdüssamet Çelebi (ORCID: https://orcid.org/0000-0002-6922-1018)
- Seval Orman (ORCID: https://orcid.org/0009-0008-6771-3263)
- Teoman Şakalar (ORCID: https://orcid.org/0000-0003-2749-9414)
- Kamil Kayaş
- Mustafa Alperen Tunç (ORCID: https://orcid.org/0000-0002-1537-3032)
- Murat Sarı (ORCID: https://orcid.org/0000-0003-0596-1559)
- Hayati Arvas (ORCID: https://orcid.org/0000-0003-2215-5567)
- Ceren Mordağ Çiçek (ORCID: https://orcid.org/0000-0002-9140-1453)
- Yeşim Ağyol (ORCID: https://orcid.org/0000-0002-4409-6003)
- Erkam Kocaaslan (ORCID: https://orcid.org/0000-0002-8994-2904)
- Fatih Şimşek (ORCID: https://orcid.org/0000-0002-8774-2861)
- İlknur Deliktaş Onur (ORCID: https://orcid.org/0000-0001-9884-5789)
- Sinem Akbaş (ORCID: https://orcid.org/0000-0002-7197-211X)
- Nadiye Sever
- Ayşe Durnalı
- Burak Paçacı (ORCID: https://orcid.org/0000-0002-9543-9053)
- Tural Guliyev
Institutions
- Dicle University (TR)
- Koç University (TR)
- Manisa Celal Bayar University (TR)
- Bezmiâlem Vakıf Üniversitesi (TR)
- Istanbul Medipol University (TR)
- Ankara Onkoloji Eğitim ve Araştırma Hastanesi (TR)
- Şanlıurfa Mehmet Akif İnan Eğitim ve Araştırma Hastanesi (TR)
- Pamukkale University (TR)
- Gaziantep University (TR)
- Marmara University (TR)
Publication Details
- Journal
- Journal of Clinical Medicine
- Published
- 2025-03-17
- DOI
- https://doi.org/10.3390/jcm14062024
- Citations
- 9
- Primary Topic
- Sarcoma Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 13.67