Abstract
OBJECTIVE: To explore the value of preoperative prognostic nutritional index (PNI) and systemic immune inflammation index (SII) for predicting the efficacy and prognosis of patients with osteosarcoma undergoing neoadjuvant chemotherapy (NACT) combined with surgery. METHODS: A retrospective study was conducted on patients with osteosarcoma undergoing NACT combined with surgery in Sun Yat-sen University Cancer Center from January 2017 to May 2019. The patients were grouped into a remission group (pCR group, 85 patients) and a non-remission group (non-pCR, 79 patients), according to the treatment efficacy. The pathological data as well as clinical data were collected from patients, which were subsequently employed for statistical analysis to determine the factors affecting the efficacy of the treatment. The diagnostic value of PNI and SII for predicting the efficacy were assessed through following up the patients for 5 years to observe their overall survival rate. COX regression analysis was leveraged to identify risk factors affecting the survival time. The impact of different PNI and SII levels on the survival time was observed. RESULTS: Multivariate regression analysis showed that factors including Enneking stage, PNI level and SII level were in association with poor efficacy after NATC combined with surgery. The mortality within 5 years was higher and the 5-year overall survival rate was lower in the non-pCR group than those in the pCR group (both P < 0.05). The COX regression analysis indicated that PNI and SII levels were risk factors for poor prognosis in patients with osteosarcoma following NACT combined with surgery. Further analysis showed that patients with low PNI and high SII levels had a lower 5-year survival rate (P < 0.05). CONCLUSION: Enneking stage, PNI, and SII levels were risk factors for poor efficacy in patients with osteosarcoma after NACT combined with surgery. Patients whose PNI level was low and SII level was high presented poor prognosis following the treatment.