Prognostic value of hemogram parameters in osteosarcoma: The French OS2006 experience

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Abstract
Background: Previous studies have shown that neutrophil‐to‐lymphocyte (NLR) ratio at diagnosis and early lymphocytes recovery on doxorubicin‐based chemotherapy, may impact the outcome in patients with osteosarcoma (OST). This study aimed to evaluate the prognostic value of hemogram parameters in patients with OST treated with high‐dose methotrexate and etoposide/ifosfamide (M‐EI) chemotherapy. Materials and methods: We retrospectively analyzed the prognostic value of various hemogram parameters at diagnosis and during therapy in a large consecutive cohort of patients with OST included in the French OS2006 trial and treated with M‐EI chemotherapy. Results: A total of 164 patients were analyzed. The median age was 14.7 years (interquartile range [IQR]: 11.7–17). Median follow‐up was 5.6 years (IQR: 3.3–7.7 years). Three‐year event‐free survival (EFS) and overall survival (OS) were 71.5% (95% confidence interval [CI]: 64%–78%) and 86.4% (95% CI: 80%–91%), respectively. In univariate analysis, blood count parameters at diagnosis and early lymphocyte recovery at Day 14 were not found prognostic of survival outcomes. By contrast, an increase of NLR ratio at Day 1 of the first EI chemotherapy (NLR‐W4) was associated with reduced OS in univariate ( p = .0044) and multivariate analysis (hazards ratio [HR] = 1.3, 95% CI: 1.1–1.5; p = .002), although not with EFS. After adjustment on histological response and metastatic status, an increase of the ratio NLR‐W4 of 1 was associated with an increased risk of death of 30%. Conclusions: We identified NLR‐W4 as a potential early biomarker for survival in patients with OST treated with M‐EI chemotherapy. Further studies are required to confirm the prognostic value of NLR and better identify immune mechanisms involved in disease surveillance.

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