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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(03): s00451810032
DOI: 10.1055/s-0045-1810032
Original Article

High Levels of Systemic Inflammatory Markers Associated with Metastasis Incidence in Osteosarcoma

Níveis altos de marcadores inflamatórios sistêmicos associados à incidência de metástase em osteossarcoma
I. Gede Eka Wiratnaya 
1   Department of Orthopedics and Traumatology, Faculty of Medicine, Udayana University, Prof. Ngoerah General Hospital, Bali, Indonesia
,
Mohamad Dimas Ismail
1   Department of Orthopedics and Traumatology, Faculty of Medicine, Udayana University, Prof. Ngoerah General Hospital, Bali, Indonesia
,
Risang Haryo Raditya
1   Department of Orthopedics and Traumatology, Faculty of Medicine, Udayana University, Prof. Ngoerah General Hospital, Bali, Indonesia
,
I. Putu Dema Prasetya
1   Department of Orthopedics and Traumatology, Faculty of Medicine, Udayana University, Prof. Ngoerah General Hospital, Bali, Indonesia
› Author Affiliations
Financial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
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Abstract

Objective

The present study explores the association between these inflammatory markers and metastasis in osteosarcoma patients.

Methods

We conducted a retrospective analysis of osteosarcoma patients at our center between January 2022 and August 2024. We collected the clinical and laboratory data of the patients, including white blood cell differential count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), neutrophil-to-lymphocyte ratio (NLR), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels. Statistical correlation between these markers and metastasis was assessed using the Pearson's Chi-squared test, the Fisher's exact test, and logistic regression.

Results

A total of 40 osteosarcoma patients were included. Elevated levels of neutrophil count (p = 0.024; odds ratio [OR] = 12.667; 95%CI = 1.402–114.419), CRP (p < 0.001; OR = 17.000; 95%CI = 3.464–83.436), ESR (p = 0.009; OR = 19.000; 95%CI = 2.119–170.383), NLR (p = 0.006; OR = 7.429; 95%CI = 1.778–31.040), and LDH (p = 0.009; OR = 9.333; 95%CI = 2.180–39.962) were significantly associated with the presence of metastasis.

Conclusion

The neutrophil count, ESR, NLR, and the levels of CRP and LDH are significantly associated with metastasis in osteosarcoma, and they may serve as valuable prognostic markers. Future research should focus on elucidating the mechanisms underlying this relationship and exploring therapeutic interventions targeting inflammation to mitigate metastasis.

Resumo

Objetivo

Este estudo explora a associação entre esses marcadores inflamatórios e metástase em pacientes com osteossarcoma.

Métodos

Realizamos uma análise retrospectiva de pacientes com osteossarcoma de nosso centro entre janeiro de 2022 e agosto de 2024. Coletamos dados clínicos e laboratoriais dos pacientes, incluindo contagem diferencial de leucócitos, níveis de proteína C reativa (PCR), velocidade de hemossedimentação (VHS), razão neutrófilo-linfócito (RNL) e concentrações de fosfatase alcalina (FA) e lactato desidrogenase (LDH). A correlação estatística entre esses marcadores e metástase foi avaliada por meio dos teste do Qui-quadrado de Pearson, exato de Fisher e regressão logística.

Resultados

O estudo incluiu 40 pacientes com osteossarcoma. Níveis altos de contagem de neutrófilos (p = 0,024; razão de chances [RC] = 12,667; IC95% = 1,402–114,419) de PCR (p < 0,001; RC = 17,000; IC95% = 3,464–83,436), VHS (p = 0,009; RC = 19,000; IC95% = 2,119–170,383), RNL (p = 0,006; RC = 7,429; IC95% = 1,778–31,040) e LDH (p = 0,009; RC = 9,333; IC95% = 2,180–39,962) foram significativamente associados à presença de metástase.

Conclusão

A contagem de neutrófilos, a VHS, a RNL e os níveis de PCR e LDH estão significativamente associados à metástase em osteossarcoma, e podem ser marcadores prognósticos valiosos. Pesquisas futuras devem se concentrar em elucidar os mecanismos subjacentes a essa relação e explorar intervenções terapêuticas direcionadas à inflamação para mitigar a metástase.

Keywords

blood sedimentation - bone neoplasms - C-reactive protein - L-lactate dehydrogenase - osteosarcoma

Palavras-chave

L-lactato desidrogenase - neoplasias ósseas - osteossarcoma - proteína c-reativa - sedimentação sanguínea

Authors' Contributions

All contributors played a significant role in the development of the manuscript and engaged in a thorough review process before its submission. IGEW was responsible for the conceptualization of this study. MDI was responsible for drafting the initial version of the document. RHR and IPDP made noteworthy contributions to the formatting and refinement of the manuscript. Finally, IGEW conducted a critical revision for intellectual rigor and was accountable for the final proofreading of the article.


Work developed at Department of Orthopaedic & Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Bali, Indonesia.




Publication History

Received: 04 December 2024

Accepted: 22 May 2025

Article published online:
08 September 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
I. Gede Eka Wiratnaya, Mohamad Dimas Ismail, Risang Haryo Raditya, I. Putu Dema Prasetya. High Levels of Systemic Inflammatory Markers Associated with Metastasis Incidence in Osteosarcoma. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451810032.
DOI: 10.1055/s-0045-1810032