Prognostic significance of serum alkaline phosphatase measurements in patients with osteosarcoma treated with adjuvant or neoadjuvant chemotherapy

Abstract

Background. It is known that many patients with osteosarcoma have high serum alkaline phosphatase (SAP) levels. The prognostic significance of this finding, however, is still controversial. Methods. The pretreatment SAP levels of 656 patients with osteosarcoma of the extremities (107 metastatic and 549 localized at presentation) were examined to evaluate whether the enzyme levels had a clinical value in predicting the course of the disease. Results. The percentage of patients with increased SAP levels was significantly higher in the metastatic group than in the group of patients with localized disease (91.5% versus 61.3%; P > 0.001). In the latter group, treated with adjuvant and neoadjuvant chemotherapy, the relapse rate was significantly higher in patients with elevated pretreatment SAP levels than in those with normal levels (55.1% versus 26.4%; P > 0.001). Among patients with elevated SAP levels, the percentage of relapses was higher in patients with high levels of the enzyme in comparison with patients with moderately elevated values (66.4% versus 47%; P > 0.05). After treatment, SAP levels almost always return to normal values, and a correlation between postoperative levels of the enzyme and prognosis could not be made. Conclusions. These data demonstrate that in osteosarcoma of the extremities, pretreatment SAP levels have a prognostic value and they should be considered when comparing the results achieved with different therapeutic protocols and in planning new randomized clinical trials.

Prognostic Significance of Serum Alkaline Phosphatase Activity in Canine Appendicular Osteosarcoma

“…Demonstration of a correlation between posttreatment BALP activity and survival in the previous study 12 would seem to imply that posttreatment BALP activities are a potential indicator of relative metastatic burden, the response of metastases to chemotherapy, or both. Although TALP activity in the early posttreatment period has not been shown to predict survival of human beings with osteosarcoma, 15,17 TALP and BALP activity during follow-up has been revealed to be significantly increased in patients with clinically apparent metastatic disease or local tumor recurrence. 14,16,19 The ideal end point for evaluation of the results of clinical studies is controversial.…”

“…14 Several studies have revealed that in human patients receiving surgery and chemotherapy, recurrence rates are higher among patients with increased TALP activity before treatment than among patients with normal activity. [15][16][17] At the time of diagnosis, human patients with clinically detectable metastases are more likely than patients with localized disease to have increased TALP activity. 17 Activity of TALP in the early period after treatment has not been revealed to correlate with survival, 15,17 although development of increased TALP activity during follow-up often heralds the appearance of clinically apparent metastases or local tumor recurrence.…”

Comparison of the Outcome of Conventional Osteosarcoma at Two Specialist International Orthopaedic Oncology Centres

“…However, variation in methodology has led to inconsistent results and difficulty in interpreting the true prognostic effect of many of the variables evaluated. [7][8][9][10][11][12][13] In any case, most of the prognosticators reported lack specificity as pre-treatment predictive factors, thus preventing their use as a basis for a more differentiated algorithm of risk-adapted chemotherapeutic and surgical intervention. Furthermore, few studies have looked at whether these prognostic factors are equally pertinent in different therapeutic and geographical populations.…”

Neoadjuvant chemotherapy for high‐grade central osteosarcoma of the extremity

“…[7][8][9][10][11][12][13][14][15] However, the prognostic significance of other variables such as alkaline phosphatase (AP), serum lactate dehydrogenase, tumor volume and site, age, and gender, is still controversial. [15][16][17][18][19][20][21][22][23][24] The prognostic significance of the histologic subtypes of PHGCO has received little attention. One study, 25 based on a large series, recognized subtypes as separate entities and determined correlations between these subtypes and histologic response to primary chemotherapy as well as survival.…”