Significance of the pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in predicting the response to neoadjuvant chemotherapy and survival rates in extremity osteosarcoma: a multicentre prospective study.

ObjectivesWe aimed to assess the effects of pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios on the response to neoadjuvant chemotherapy and survival rates in patients with extremity osteosarcoma.Patients and methodsPatients with high-grade osteosarcoma admitted to oncologic centers affiliated to Iran University of Medical Sciences, Tehran, Iran from 2015 to 2021 were evaluated retrospectively to assess the impact of complete blood count related parameters on the pathologic response after neoadjuvant chemotherapy. Then, patients were followed up prospectively to evaluate the survival rates. All patients received at least three cycles of cisplatin/doxorubicin regimen, preoperatively. A cut-off values for high neutrophil-to-lymphocyte and high platelet-to-lymphocyte ratio were considered 3.28 and 128, respectively.ResultsOne hundred eighty-six patients were enrolled. Patients with high neutrophil-to-lymphocyte ratio and high platelet-to-lymphocyte ratio had a significantly lower overall survival rates (20.7 [95%CI 18 - 23.5] month vs 34.6 [95%CI 33.2 - 36], p = 0.003 and 21.9 [95%CI 20.2 - 23.6] month vs 35.3 [95%CI 33.9 - 36.7], p = 0.002; respectively). Moreover, disease free survival of patients with high platelet-to-lymphocyte ratio was worse than patients with low platelet-to-lymphocyte ratio (20.4 [95%CI 18.4 - 22.4] month vs 32.7 [95%CI 30.8 - 34.7], p = 0.02).ConclusionOur study showed that neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios at the baseline can predict the survival of patients with high grade osteosarcoma.