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. 2025 Mar 17;14(6):2024.
doi: 10.3390/jcm14062024.

Prognostic Factors in High Grade Osteosarcoma Patients Who Received Neoadjuvant Therapy and Subsequently Underwent Surgery: Data from the Turkish Oncology Group

Nadiye Sever  1 , Fatih Şimşek  2 , İlknur Deliktaş Onur  3 , Hayati Arvas  4 , Tural Guliyev  5 , Teoman Şakalar  6 , Ceren Mordağ Çiçek  7 , Seval Orman  8 , Emine Bihter Çetin  9 , Kamil Kayaş  10 , Sinem Akbaş  11 , Yeşim Ağyol  1 , Ali Kaan Güren  1 , Pınar Erel  1 , Erkam Kocaaslan  1 , Burak Paçacı  1 , Mustafa Alperen Tunç  1 , Abdussamet Çelebi  1 , Nargiz Majidova  1 , Ayşe Durnalı  3 , Melih Şimşek  5 , Mustafa Şahbazlar  9 , Selver Işık  1 , Rukiye Arıkan  1 , Özlem Ercelep  1 , Murat Sarı  12 , Osman Köstek  12 , İbrahim Vedat Bayoğu  1
Affiliations

Prognostic Factors in High Grade Osteosarcoma Patients Who Received Neoadjuvant Therapy and Subsequently Underwent Surgery: Data from the Turkish Oncology Group

Nadiye Sever et al. J Clin Med. .

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Keywords: neoadjuvant chemotherapy; osteosarcoma; prognostic factors; survival analysis; tumor necrosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure A1
Figure A1
Inclusion criteria of study patients.
Figure 1
Figure 1
Kaplan–Meier curves for overall survival by treatment groups.
Figure 2
Figure 2
Kaplan–Meier survival curves for overall survival based on necrosis rate.
Figure 3
Figure 3
Kaplan–Meier survival curves for overall survival based on ALP levels.
See this image and copyright information in PMC

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