Background: Dominant negative inhibition of nuclear factor kB (NFkB) signalling activity in a human osteosarcoma cell line (Saos2) results in malignant reversion and the induction of the osteoblast differentiating transcription factor, Runx2/ Cbfa1. This observation suggests that there is an inverse relation between a transcription factor associated with malignant progression and chemoresistance (NFkB) and an osteoblast differentiating transcription factor (Runx2/Cbfa1). Aims: To assess and correlate Runx2/Cbfa1 and NFkB (p65) immunoreactivity in human osteosarcoma. Methods: Runx2/Cbfa1 and NFkB (p65) immunoreactivity was assessed on 11 paraffin wax embedded archival specimens of human primary osteosarcoma by standard immunohistochemical methods and scored on a scale of 0-3. A Pearson correlation analysis between Runx2/Cbfa1 and NFkB (p65) scores was established. Results: Runx2/Cbfa1 was expressed constitutively in all pathology specimens of human osteosarcoma. Of note, a chondroblastic osteosarcoma showed the highest Runx2/ Cbfa1 immunoreactivity. A Pearson correlation did not support an inverse correlation between Runx2/Cbfa1 and NFkB (p65) scores (r = 0.57) in human osteosarcoma. Conclusion: Runx2/Cbfa1 immunoreactivity does not inversely correlate with NFkB immunoreactivity, and thus cannot serve as an indirect measure of NFkB activity or an independent predictive or prognostic indicator. O steosarcoma is the most common primary bone malignancy, with a propensity for pulmonary metastasis and a predilection for paediatric and geriatric age groups. The cornerstone of current clinical management involves high dose neoadjuvant chemotherapy, to which 40-60% of cases are non-responsive. Thus, prognosticating, stratifying, and individualising treatment is crucial for optimal and cost effective management. 1 ''Although the NFkB activation status of a tumour has predictive and prognostic value, it cannot be measured by routine laboratory investigations'' Histopathologically, osteosarcomas are characterised by atypical cells (osteoblasts, mesenchymal cells, fibroblasts, and chondrocytes) enmeshed in a disorganised bony matrix (immature osteoid). We recently showed that dominant negative inhibition of the promalignant transcription factor, nuclear factor kB (NFkB), in a human osteosarcoma cell line (Saos2) results in malignant reversion and the induction of the osteoblast differentiating transcription factor, Runx2/ Cbfa1.2 3 This finding was interesting for two reasons:N It validated the concept that cellular differentiation and transformation are mutually exclusive processes.N It suggested an inverse relation between a transcription factor associated with malignant progression 4 and chemoresistance (NFkB) 5 and an osteoblast differentiating transcription factor (Runx2/Cbfa1).Although the NFkB activation status of a tumour has predictive and prognostic value, it cannot be measured by routine laboratory investigations. Our present study was designed to assess whether Runx2/Cbfa1 expression could serve as an indirect me...