title: Prognostic Significance of Serum Alkaline Phosphatase Level in Osteosarcoma: A Meta-Analysis of Published Data.
abstract: BACKGROUND
  Serum alkaline phosphatase (SALP) is commonly elevated in osteosarcoma patients. A number of studies have investigated the prognostic role of SALP level in patients with osteosarcoma but yielded inconsistent results.
  
  
  METHODS
  Systematic computerized searches were performed in PubMed, Embase, and Web of Science databases for relevant original articles. The pooled hazard ratios (HRs) and relative risks (RRs) with corresponding confidence intervals (CIs) were calculated to assess the prognostic value of SALP level.
  
  
  RESULTS
  Finally, 21 studies comprising 3228 patients were included. Overall, the pooled HRs of SALP suggested that elevated level had an unfavorable impact on osteosarcoma patients' overall survival (OS) (HR = 1.82; 95% CI: 1.61-2.06; p < 0.001) and event-free survival (EFS) (HR = 1.97; 95% CI: 1.61-2.42; p < 0.001). Combined RRs of SALP indicated that elevated level was associated with presence of metastasis at diagnosis (RR = 5.55; 95% CI: 1.61-9.49; p = 0.006). No significantly different results were obtained after stratified by variables of age range, cancer stage, sample size, and geographic region.
  
  
  CONCLUSIONS
  This meta-analysis demonstrated that high SALP level is significantly associated with poor OS or EFS rate and presence of metastasis at diagnosis. SALP level is a convenient and effective biomarker of prognosis for osteosarcoma.
authors.affiliation: Department of Orthopaedics, Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China.
authors.forename: Hai-Yong
authors.initials: HY
authors.lastname: Ren
authors.affiliation: Department of Orthopaedics, Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China.
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Sun
authors.affiliation: Department of Orthopaedics, Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China.
authors.forename: Heng-Yuan
authors.initials: HY
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Second Affiliated Hospital, College of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China.
authors.forename: Zhao-Ming
authors.initials: ZM
authors.lastname: Ye
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood*; D000818:Animals; D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D006801:Humans; D012516:Osteosarcoma / Q000097:blood* / Q000473:pathology*; D011379:Prognosis
chemical_list: D014408:Biomarkers, Tumor; D000469:Alkaline Phosphatase