title: Pre- and post-chemotherapy alkaline phosphatase levels as prognostic indicators in adults with localised osteosarcoma.
abstract: The prognostic value of alkaline phosphatase (AP) measured before and after chemotherapy, but before surgery was established in a retrospective survey of patients. The patients were 18 years or older, with non-metastatic high-grade osteosarcoma. Pre-chemotherapy AP was available in 89 cases, post-chemotherapy AP in 86 patients, and both in 71 cases. AP was classified as Normal (< 100% upper limit), High (100% < or = AP < 200%) or Very High (AP > or = 200%). Osteosarcoma subtype was predominantly conventional. No correlation was found between subtype and chemotherapy response, local recurrence or survival. Pre-chemotherapy AP was raised more in the osteoblastic subtype. Post-chemotherapy AP and normalisation were the same among different subtypes. AP was not correlated with local recurrence. Normal or High pre-chemotherapy AP correlated with better survival at 10 years (64% and 70%) than Very High pre-chemotherapy AP (37%, P = 0.005). Post-chemotherapy AP correlated with survival (68%, 39% and 25% in the Normal, High and Very High group, P = 0.0007) and response to chemotherapy (P = 0.049). A pre-chemotherapy AP above twice Normal correlated with worse survival. If AP decreased after chemotherapy, but was still raised, survival was better, but still worse than if AP normalised. A raised post-chemotherapy AP predicts poor chemotherapy response.
authors.affiliation: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham B31 2AP, UK. jbramer@wxs.nl
authors.forename: Jos A M
authors.initials: JA
authors.lastname: Bramer
authors.forename: Adesegun A
authors.initials: AA
authors.lastname: Abudu
authors.forename: Roger M
authors.initials: RM
authors.lastname: Tillman
authors.forename: Simon R
authors.initials: SR
authors.lastname: Carter
authors.forename: Vaiyapuri P
authors.initials: VP
authors.lastname: Sumathi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Grimer
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism*; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000201:enzymology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000188:drug therapy / Q000201:enzymology*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D000469:Alkaline Phosphatase