Anemia can predict prognosis and response to neoadjuvant chemotherapy in osteosarcoma at pre-operative stage: a retrospective analysis

Purpose: Anemia is relatively common in cancer patients, and is associated with poor survival in patients with various malignancies. However, how anemia would affect prognosis and response to neoadjuvant chemotherapy(NAC) in osteosarcoma(OS) is still without substantial evidence. Methods We retrospectively analyzed 256 OS patients who underwent standard NAC in our institute. Hb concentrations before/after NAC and changed Hb levels (dHb, Hb level before NAC minus that after NAC) were recorded to assess their prognostic value in DFS(disease-free survival) and tumor necrosis rate to NAC. Results There was higher percentage of pretreatment anemia in poor response group(87 out of 181) with a tumor necrosis rate < 90%, compared with those in good response group(36 out of 75). Besides, in patients with good response to NAC, the median dHb was 13, which was smaller than that(median dHb 18) in poor response to NAC. Further ROC analysis demonstrated that dHb had a significant role in prediction for the NAC response in OS patients.In survival analysis, patients with high dHb(≥ 12.5) had an inferior DFS(38 ± 2.44 months), compared with those with dHb below 12.5(47 ± 7.26 months). Conclusion In osteosarcoma, dynamic Hb decrease after NAC predicted poor survival and worse response to neoadjuvant chemotherapy. Pretreatment anemia might be a potential indicator to forecast response to NAC. Attempts to correct anemia and their effects on outcomes for osteosarcoma patients should be explored in future studies.