Abstract
BackgroundAt present, no predictive factor has been validated for the early efficacy of neoadjuvant chemotherapy (NACT) in osteosarcoma. The purpose of this study was to investigate the significance of the neutrophil-to-lymphocyte ratio (NLR) in predicting the response to NACT in extremity osteosarcoma.MethodsPathological complete response (pCR) was used to assess the efficacy of NACT. Receiver operating characteristic (ROC) curves and the Youden index (sensitivity + specificity-1) were used to determine the optimal cut-off values of the NLR. Univariate and multivariate analyses using logistic regression models were conducted to confirm the independent factors affecting the efficacy of NACT.ResultsThe optimal NLR cut-off value was 2.36 (sensitivity, 80.0%; specificity, 71.3%). Univariate analysis revealed that patients with a smaller tumour volume, lower stage, lower NLR and lower PLR were more likely to achieve pCR. Multivariate analyses confirmed that the NLR before treatment was an independent risk factor for pCR. Compared to patients with a high NLR, those with a low NLR showed a more than 2-fold higher likelihood of achieving pCR (OR 2.82, 95% CI 1.36-5.17, p = 0.02).ConclusionThe NLR is a novel and effective predictive factor for the response to NACT in extremity osteosarcoma patients. Patients with a higher NLR showed a lower percentage of pCR after NACT.
Highlights
Osteosarcoma, which originates from mesenchymal tissue and is mainly located in the long bones, is one of the most common primary malignant tumours in childrenTang et al BMC Cancer (2022) 22:33According to National Comprehensive Cancer Network (NCCN) recommendations, the curative effect of chemotherapy is a key index for assessing whether limb salvage is feasible [6]
The inclusion criteria were as follows: (1) patients diagnosed with osteosarcoma by postoperative histopathology; (2) patients who received standard neoadjuvant chemotherapy (NACT) before surgery; (3) patients with complete laboratory data before NACT; (4) patients who underwent tumour resection or amputation such that pathological complete response
Our results demonstrated that the tumour size in patients with a low neutrophil-to-lymphocyte ratio (NLR) was significantly smaller than that in patients with a high NLR (171.37 ± 12.94 cm3 vs. 218.34 ± 11.24 cm3, p = 0.034)
Summary
Osteosarcoma, which originates from mesenchymal tissue and is mainly located in the long bones, is one of the most common primary malignant tumours in childrenTang et al BMC Cancer (2022) 22:33According to National Comprehensive Cancer Network (NCCN) recommendations, the curative effect of chemotherapy is a key index for assessing whether limb salvage is feasible [6]. PCR is determined based on postoperative tumour specimens and cannot be validated as a predictive factor for the early efficacy of NACT. Some radiological parameters, including tumour volume, the apparent diffusion coefficient (ADC) on MRI, and standardized uptake values (SUVs) on 18F-FDG PET, have been proposed as predictive indices [8, 9]. These parameters can be measured before surgery and have relatively satisfactory reliability, measurement errors, specificity and sensitivity, and costs still need to be improved. No predictive factor has been validated for the early efficacy of neoadjuvant chemotherapy (NACT) in osteosarcoma. The purpose of this study was to investigate the significance of the neutrophil-to-lymphocyte ratio (NLR) in predicting the response to NACT in extremity osteosarcoma
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