, alkaline phosphatase levels in 30 patients with osteogenic sarcoma were closely followed in an attempt to determine if these measurements had clinical value in predicting the course of patients with this disease. Of 17 patients with elevated preoperative alkaline phosphatase levels, 12 recurred. Of 13 patients with normal preoperative alkaline phosphatase levels, only 4 recurred (p < .05). Thus, alkaline phosphatase levels that were elevated preoperatively were correlated with poor prognosis. A similar correlation between postoperative alkaline phosphatase levels and prognosis could not be made.Cancer 43:2178-2181, 1979.H E USE OF ADJUVANT CHEMOTHERAPY f01-T lowing amputation in patients with osteogenic sarcoma has been reported to substantially increase the rate of cure in this d i s e a~e . ' * '~*~~ Despite these developments, however, substantial numbers of patients recur and methods are needed to identify those poor prognosis patients that may be candidates for additional therapy. We have investigated the prognostic value of measurements of serum alkaline phosphatase (AP) in patients undergoing amputation and adjuvant chemotherapy for the treatment of osteogenic sarcoma. Elevated levels of serum AP in the preoperative tumorbearing patient appear to be correlated with a poor prognosis.
PATIENTS A N D METHODSThirty patients with osteogenic sarcoma of the extremity were included in this study. The group consisted of 25 males and five females whose ages ranged from 10 to 47 years (average 18, median 19). Patients were entered into the study between January 1975 and August 1977. The minimum follow-up was six months. Each patient's disease was limited to the extremity with no clinical evidence of metastases and all patients were rendered clinically disease-free by amputation. Serum alkaline phosphatase levels were measured in all patients preoperatively and every three weeks postoperatively. All patients were followed at the NCI Surgery Branch for evidence of metastatic disease with chest x-rays every three weeks, chest tomography every three months, and metastatic series and bone scans yearly.Serum analyses for biochemical and hematologic abnormalities including measurement of serum alkaline phosphatase were conducted every three weeks. Suspected recurrences were confirmed histologically. All patients underwent postoperative adjuvant chemotherapy as soon as the wound was healed. This consisted of methotrexate 50 mg/kg given intravenously over six hours followed by leukovoran rescue, 15 mg/m2 intravenously, repeated every six hours either iv or im for 48 hours. Doses of methotrexate were escalated to a maximum dose of 250 mg/kg. In some patients, Vincristine 2 mg/m2 was infused intravenously 30 minutes prior to the methotrexate.All serum AP levels were measured in international units ( I U ) by the method of MorgensternZ2 in the NIH clinical laboratory. The normal range, which varies by age,6 was determined by testing over 2,000 normal persons of various ages over several years. This range was as follows: 21-11...
