Preoperative Predictors of Early Mortality Risk in People with Osteosarcoma of the Extremities Treated with Standard Therapy

Abstract

More precise identification of osteosarcoma patients with high early death risk and enhanced early follow-up of these patients, such as increasing the frequency of postoperative chest computed tomography (CT) and local magnetic resonance imaging (MRI) examinations, may improve the overall survival of patients. The primary purpose of this research is to explore the risk factors related to early mortality in patients with osteosarcoma under standard treatment. Patients and Methods: Our research included 87 osteosarcoma patients who had undergone standard treatment and had a Karnofsky (KPS) ≥70. We define patients who die within 2 years of diagnosis as early death. The clinical characteristics and laboratory indicators of patients with osteosarcoma were collected and analyzed retrospectively. Results: The median follow-up time was 32 months (4-91 months). Early deaths occurred in 13 patients. Early death of patients with osteosarcoma is related to tumor metastasis (P < 0.001), tumor size >5cm (P = 0.049), high-level neutrophil-lymphocyte ratio (NLR) (P = 0.035), high-level fibrinogen (FIB) (P = 0.038), and higher D-dimer (DD) (P = 0.025). According to our results of multivariate Cox analysis, tumor metastasis status at diagnosis (P < 0.001), NLR (P = 0.039) and FIB (P = 0.023) are independent risk factors in predicting early mortality in osteosarcoma patients. The "Osteosarcoma Early Mortality Nomogram" has a C index of 0.871, and the calibration curve performs best compared with the ideal model in predicting mortality in 1 year. Conclusion: Tumor metastasis status, NLR, and FIB are independent risk factors in predicting early mortality in osteosarcoma patients. The early follow-up of patients with tumor metastasis, high NLR, and high FIB should be strengthened.

The OSR9 Regimen: A New Augmentation Strategy for Osteosarcoma Treatment Using Nine Older Drugs from General Medicine to Inhibit Growth Drive

“…This paper discusses several pathogenic mediators in OS and potential already marketed repurposed drugs to inhibit these systems, but it is important to remember that many more pathogenic physiological derangements are present in OS beyond those discussed here [196,[307][308][309][310]. As with other deadly cancers, the malignant behavior of OS cells involves deranged activation and/or pathological drop-out and/or the pathologically active participation of dozens (or hundreds) of cell-signaling systems.…”

Prognostic value of pretreatment platelet count, fibrinogen and d-dimer levels in osteosarcoma patients: A meta-analysis

“…Subsequently, only 37 studies were further assessed by fulltext reviewing. Finally, 12 studies were included in this meta-analysis, [16][17][18][19][20][21][22][23][24][25][26][27] and the flowchart of literature selection was presented in Figure 1.…”

“…The studies by Ren and Hu did not provide HRs and 95% CIs directly [19,20] thus we estimated them using survival curves. All included Yang [16] 2009 China 53 Platelet count: 300*10 9 L −1 Enneking stage IIB Surgery OS R 6 Wang [17] 2015 China 454 Platelet count: 300*10 9 L −1 Enneking stage IIA-III Surgery, chemotherapy OS R 6 Huang [18] 2016 China 32 D-dimer: 1.16 mg/mL Enneking stage III Chemotherapy OS R 7 Ren [19] 2016 China 125 Fibrinogen: 3 g/L Enneking stage IIA-III Chemotherapy OS E 8 Hu [20] 2017 China 106 Fibrinogen: 3 g/L NR Surgery, chemotherapy OS E 7 Li [21] 2017 China 233 Platelet count: 300*10 9 L −1 Enneking stage I-III Surgery, chemotherapy DFS R 7 Gou [22] 2019 China 188 Platelet count: 233*10 9 L −1 TNM stage I-III Surgery, chemotherapy DFS R 7 Huang [23] 2021 China 103 D-dimer: 3.91 mg/mL Enneking stage IIB Surgery, chemotherapy OS R 8 Yang [24] 2021 China 70 Platelet count: 266*10 9 L −1 Enneking stage II-III Mixed OS R 6 Ouyang [25] 2022 China 86 Platelet count: NR TNM I-IV Surgery CSS R 6 Pu [26] 2022 China 145 Fibrinogen: 3.34 g/L; D-dimer: 0.46 µg/mL TNM I-IV Surgery OS, DFS R 7 Tian [27] 2022 China 87 Fibrinogen: 3. studies had a NOS score of 6 or higher, suggesting a low risk of bias.…”