The effect of resistance-related proteins on the prognosis and survival of patients with osteosarcoma: an immunohistochemical analysis

Objectives: Despite the developments in chemotherapy proto¬cols, improvement in the survival rates of osteosarcoma has been limited. We evaluated the effect of certain prognosis-related pro¬teins on survival of patients with osteosarcoma. Methods: Data from 45 patients (24 males, 21 females) who were treated and followed-up for osteosarcoma were reviewed. Following neoadjuvant chemotherapy, 41 patients underwent extremity saving surgery, and four patients underwent amputa¬tion. The most frequent localization was the lower end of the femur (n=23,51.1%), followed by the upper end of the tibia (n=10, 22.2%). Three patients had metastasis on admission. Surgical re¬section samples were retrieved from the pathology archive and analyzed immunohistochemically for the expression of p-glyco- protein p170, p53, heat-shock protein 27 (HSP27), HSP90, and nm23. The effect of these proteins on prognosis and survival was assessed with survival analysis using the Kaplan-Meier method. The mean follow-up was 49.7 months (range 6 to 185 months). Results: Three patients with metastasis on admission died within five years due to pulmonary metastasis. New metastases developed in 29 patients. Total 5-year and 10-year survival rates were 60% and 43%, respectively. The corresponding disease- free survival rates were 41% and 24%. Five-year survival was 29% in patients who developed metastasis. Among clinical fac¬tors, survival was influenced only by the presence of metastasis on admission (p=0.044). Five-year and 10-year survival rates were significantly different between patients with and without p53 positivity (p=0.04), while the other proteins were not signifi¬cantly associated with survival. Conclusion: Our data suggest that p53 may be used as a prognostic marker in osteosarcoma due to its significant as¬sociation with survival.