title: SDF-1 Expression is Associated with Poor Prognosis in Osteosarcoma.
abstract: BACKGROUND
  Stromal cell-derived factor-1 (SDF-1) expression has been reported to be a predictor of poor clinical symptoms in certain types of cancer. Vascular endothelial growth factor (VEGF) is a well-known factor that mediates the micro-angiogenesis of solid tumors, and SDF-1 mediated expression of VEGF may promote tumor growth and metastasis, resulting in poor clinical outcome. Therefore, we explored the expression levels of SDF-1 and VEGF in patients with osteosarcoma in order to determine the association between their expression levels and unfavorable outcomes.
  
  
  METHODS
  A total of 54 patients with osteosarcoma were included in the current study. The protein expression levels of SDF-1 and VEGF were evaluated on immunohistochemical and immunofluorescence staining. The correlation between the expression levels of SDF-1 and VEGF and their association with clinical parameters were analyzed using the Pearson chi-square test and the Spearman-rho test. Univariate and multivariate Cox regression analyses were used to identify potential prognostic factors. The Kaplan-Meier method was employed to analyze overall survival.
  
  
  RESULTS
  Low SDF-1 and VEGF expression levels were detected in 20.4% (11 of 54) and 22.2% (12 of 54) of the patients with osteosarcoma, respectively; moderate expression was detected in 35.2% (19 of 54) and 37.0% (20 of 54) of the patients, respectively; and high expression was detected in 44.4% (24 of 54) and 40.7% (22 of 54) of the patients, respectively. Protein levels of both SDF-1 and VEGF were significantly associated with the histologic grade (p=0.004 and p=0.042 respectively), the presence of metastasis (p=0.009 and p=0.028 respectively), and Enneking staging (p<0.001 and p=0.003 respectively). The association between expression levels of SDF-1and VEGF had a significantly positive correlation (p<0.001and r=0.618). The expression levels of both SDF-1 and VEGF were significantly associated with shorter overall survival on univariate analysis; however, the association was significant for SDF-1 expression alone in the multivariate analysis (p=0.26, hazard ratio =2.640 [1.124-6.200]).
  
  
  CONCLUSIONS
  SDF-1 and VEGF expression levels were both significantly associated with osteosarcoma, and SDF-1 expression is a potential independent prognostic indicator in patients with osteosarcoma.
authors.affiliation: Department of Orthopedics, Jizhong Energy Fengfeng Group Hospital, Handan, Hebei, P. R. China.
authors.forename: Dangen
authors.initials: D
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, Jizhong Energy Fengfeng Group Hospital, Handan, Hebei, P. R. China.
authors.forename: Fei
authors.initials: F
authors.lastname: Lv
authors.affiliation: Department of Orthopedics, Jizhong Energy Fengfeng Group Hospital, Handan, Hebei, P. R. China.
authors.forename: Jianhe
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Jizhong Energy Fengfeng Group Hospital, Handan, Hebei, P. R. China gukelihongjie@163.com.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D054377:Chemokine CXCL12 / Q000378:metabolism*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012516:Osteosarcoma / Q000378:metabolism* / Q000473:pathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: C515255:CXCL12 protein, human; D054377:Chemokine CXCL12; D042461:Vascular Endothelial Growth Factor A
keywords: SDF-1; VEGF; osteosarcoma; prognostic indicator; soft tissue sarcoma