title: Alkaline phosphatase level change in patients with osteosarcoma: its role as a predictive factor of tumor necrosis and clinical outcome.
abstract: BACKGROUND
  In osteosarcoma the histological response, measured by the percentage of tumor necrosis, constitutes one of the most significant predictive factors, with better survival in patients whose tumor necrosis is > or = 90%.
  
  
  OBJECTIVE
  To determine if the decrease rate of serum alkaline phosphatase (SAP) levels during the first month of neoadjuvant chemotherapy could serve as a predictive indicator of tumor necrosis and clinical outcome.
  
  
  METHODS
  We analyzed the medical files of 53 osteosarcoma patients (19 females, 34 males) (median age 16 years, range 8-24); the disease was metastatic in 12 and localized in the other 41.
  
  
  RESULTS
  The histological responses were good in 38 patients (71.7%) and poor in 15 (28.3%). At a median follow-up of 50 months, 34 patients (64.2%) had no evidence of disease and 19 (35.8%) had died from the disease. High levels of SAP at diagnosis correlated with worse survival (P = 0.002). There was no difference in overall survival between patients whose SAP decrease rate was > 25% and those with a rate < 25% (P = 0.14). Among female patients, "rapid" SAP responders had better survival than "slow" responders (P= 0.026). In patients with metastases the SAP decrease rate was positively correlated with survival (P = 0.042).
  
  
  CONCLUSIONS
  There was no evidence that "rapid" SAP responders had a higher percentage of tumor necrosis than "slow" responders, although female "rapid" SAP responders had a better prognosis than "slow" responders. Patients with metastases at presentation and "rapid" SAP response had better prognoses.
authors.affiliation: Department of Pediatric Hematology Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Johad F
authors.initials: JF
authors.lastname: Khoury
authors.affiliation: Department of Pediatric Hematology Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Myriam Weyl
authors.initials: MW
authors.lastname: Ben-Arush
authors.affiliation: Department of Pediatric Oncology/Hematology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Weintraub
authors.affiliation: Department of Pediatric Oncology/Hematology, Hadassah Medical Center and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: Elisha
authors.initials: E
authors.lastname: Waldman
authors.affiliation: Clinical Epidemiology Unit, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Boris
authors.initials: B
authors.lastname: Futerman
authors.affiliation: Department of Pathology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Eugene
authors.initials: E
authors.lastname: Vlodavsky
authors.affiliation: Department of Pediatric Hematology Oncology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Sergey
authors.initials: S
authors.lastname: Postovsky
mesh_terms: D000293:Adolescent; D000469:Alkaline Phosphatase / Q000378:metabolism*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009336:Necrosis / Q000473:pathology; D020360:Neoadjuvant Therapy / Q000379:methods*; D009362:Neoplasm Metastasis; D012516:Osteosarcoma / Q000188:drug therapy / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D000469:Alkaline Phosphatase