Abstract
BackgroundOsteosarcoma is a malignant tumor with high ability to form invasion and metastasis. Identifying prognostic factor in osteosarcoma is helpful to select those patients for more aggressive management. Our study evaluated serum alkaline phosphatase (ALP) cooperating with matrix metalloproteinase-9 (MMP-9) as an important prognostic predictor for local recurrence and distant metastasis of osteosarcoma.Methods177 cases were included from the osteosarcoma patients treated at 1st Affiliated Hospital of Sun Yat-sen University (1999-2008). Pre-chemotherapy serum ALP (pre-ALP) were studied and correlated with tumor recurrence, lung metastasis and patient survival. MMP-9 protein in tumor tissues was detected by immunohistochemistry and correlated with pre-ALP level.ResultsPre-ALP were partitioned into normal, high, and very high groups, in each group the incidence of metastases was 12.2%, 21.2% and 34.6%, respectively (p = 0.007). In the three groups the mean disease-free survival (DFS) was 57 ± 3.15, 28 ± 3.57 and 14 ± 3.35 months, respectively (p < 0.001); overall survival (OS) was 92 ± 26.89, 39 ± 8.61 and 17 ± 5.07 months, respectively (p < 0.001). By multivariate analysis, elevated serum pre-ALP were associated with shorter DFS (p = 0.018) and OS (p = 0.031). If elevated ALP levels decreased after clinical treatment, the incidence of lung metastasis rate decreased (p = 0.028); DFS and OS were both prolonged (p < 0.001). Pre-ALP was also positively correlated with MMP-9 expression (p = 0.015) in tumor tissue.ConclusionsPre-ALP was an independent prognostic factor for the survival of osteosarcoma patients in south China, and correlated with MMP-9 expression and lung metastasis. ALP can also serve as a prognostic marker for treatment, and merit large-scale validation studies.
Highlights
Osteosarcoma is a malignant tumor with high ability to form invasion and metastasis
matrix metalloproteinase-9 (MMP-9) expression and function is involved during lung metastasis of tumor, so we concerned whether serum alkaline phosphatase (ALP) was connected with matrix metalloproteinases (MMPs)-9 expression
Pre-ALP is associated with an improved prognosis in order to elucidate the possible relationship between Pre-chemotherapy serum ALP (pre-ALP) levels and patient survival, we demonstrated a positive correlation with decreased disease-free survival (DFS) and overall survival (OS)
Summary
Osteosarcoma is a malignant tumor with high ability to form invasion and metastasis. Identifying prognostic factor in osteosarcoma is helpful to select those patients for more aggressive management. Our study evaluated serum alkaline phosphatase (ALP) cooperating with matrix metalloproteinase-9 (MMP-9) as an important prognostic predictor for local recurrence and distant metastasis of osteosarcoma. Serum alkaline phosphatase (ALP) can be demonstrated in osteosarcoma patients, which may be predictive of survival [5,6,7,8]. This remains controversial [9]. We examined whether or not serum ALP was predictive of lung metastasis, local recurrence and survival after surgery of osteosarcoma patients in south China. MMP-9 expression and function is involved during lung metastasis of tumor, so we concerned whether serum ALP was connected with MMP-9 expression
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