Potential of Inflammatory and Nutritional Markers and Clinicopathological Factors for Prognostic Prediction in Osteosarcoma

Background/Aim: Prognostic factors for osteosarcoma remain insufficiently defined. This study evaluated the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), and prognostic nutritional index (PNI), and examined their associations with clinicopathological factors.

Patients and Methods: Eighteen patients with osteosarcoma treated at our institution were retrospectively analyzed. NLR, SIRI, and PNI were calculated from pretreatment blood tests. Associations between each index and clinical factors – including stage, lung metastasis, distant metastasis, and local recurrence – were assessed using the Kaplan–Meier method and Cox proportional hazards regression.

Results: The median follow-up was 79 months. Eight patients (44.4%) died of disease. In univariate analysis, stage was the only significant prognostic factor (HR=1.681, p=0.0308). Lung metastasis showed borderline significance (HR=3.593, p=0.0817). PNI demonstrated borderline significance in Kaplan–Meier analysis (p=0.0880) and was lower in patients who died (50.03 vs. 54.93). In multivariate analysis, the PNI-adjusted model showed the highest concordance index (0.704). NLR and SIRI were not independent prognostic factors but tended to be elevated in advanced-stage disease and in patients with lung metastasis.

Conclusion: Although PNI was not an independent prognostic factor, it demonstrated clinical relevance as an indicator of nutritional and immune status. NLR and SIRI may reflect tumor progression. An integrated risk assessment combining stage, lung metastasis, and PNI may improve prognostic prediction in osteosarcoma.