Evaluation of the Receptor Activator of Nuclear Factor Kappa B Ligand (RANKL) Expression in Osteosarcoma and Its Association with the Clinicopathological Data

Abstract

Background:The receptor activator of nuclear factor kappa B ligand (RANKL) is one of the key regulators of bone remodelling in bone oncology, including osteosarcoma. We assessed RANKL immunohistochemical expression in osteosarcoma, its association, and disease-free survival with the patients' clinicopathological characteristics. Methods: One hundred osteosarcoma cases from 2003 to 2018 in Hospital Universiti Sains Malaysia were retrieved. The tissue samples were stained for RANKL, and the association with the clinicopathological characteristics was evaluated. Staining was interpreted in a semiquantitative scoring system and classified into negative and positive expressions. Results: Eighty-two cases had a positive expression of RANKL in which 56 and 26 patients were classified as low expression and high expression, respectively. The positive expression of RANKL did not show a significant association with clinicopathological characteristics. However, Kaplan Meier survival analysis showed a significant improvement in the disease-free survival patients who underwent limb salvage surgery (LSS) than amputated patients (p-value 0.002), whereas poorer survival was observed among conventional osteosarcomas compared to non-conventional osteosarcoma (p-value 0.01). Conclusion: Limb salvage surgery had proven to improve osteosarcoma patients' survival compared to amputation, which could improve overall quality of life in osteosarcoma patients. However, our data did not show a significant association between positive RANKL immunohistochemistry with any of the clinicopathological characteristics and patients' final survival. Further studies may be acquired to understand the suitability of using RANKL immunohistochemistry as prognostication in the management of osteosarcoma patients.

Comprehensive conservative treatment for multiple metastases of skull osteosarcoma: A case report

“…It is often used in clinical practice for bone metastases, multiple myeloma, and giant cell tumor of bone in solid tumors dominated by osteolytic destruction, and can also be used for secondary osteoporosis of tumors ( 20 , 21 ). Studies have reported the expression of RANKL in osteosarcoma ( 22 – 25 ). Animal models of osteosarcoma have confirmed that RANKL blockade can prevent tumor progression, improve survival rate and inhibit pulmonary metastasis ( 26 ).…”

Cellular Cannibalism: Suggesting a Histopathological Parameter for Predicting Metastasis of Osteosarcoma in Future Studies

“…I read with great interest the article of Chua et al, (2021) entitled "Evaluation of the receptor activator of nuclear factor kappa B ligand (RANKL) expression in osteosarcoma and its association with the clinicopathological data". Osteosarcoma (OS) is the most common primary malignant tumor in children and young adults, associated with high morbidity.…”