High serum amyloid A (SAA) and low CXC chemokine ligand 4 (CXCL4) at time of initial diagnosis are associated with poorer prognosis in patients with osteosarcoma, according to a study conducted by Ricardo J. Flores, MD, assistant professor in the Department of Pediatrics, Section of Hematology-Oncology, at Baylor College of Medicine in TX.1

Osteosarcoma is the most common type of bone cancer in children, with a survival rate between 60% and 70%. Because the survival rate of these patients has remained stagnant for the past 4 decades, Dr Flores sought to identify biomarkers that can better predict outcomes in patients with osteosarcoma and guide treatments decisions that would improve survival.

For the study, Dr Flores used ELISA assays to evaluate the expression of 2 SAA and CXCL4, circulating biomarkers that have been previously identified, in 223 serum samples collected from the Children’s Oncology Group at initial diagnosis.

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Results showed that patients with high SAA and low CXCL4 levels had significantly poorer outcome in terms of 5-year overall survival (HR, 1.68; P = .014). This correlation was independent of initial metastasis status.

Dr Flores found that patients considered high-risk had a 5-year overall survival rate of 47% (95% CI, 36 – 62), while patients classified as low-risk had a 5-year survival rate of 64% (95% CI, 57 – 72). Further, the study demonstrated that low tumor expression of CXCL4 was associated with poor survival in an osteosarcoma tissue microarray (P = .017).

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The findings suggested that this prognostic model could potentially serve as the basis for future biomarker-guided clinical trials by treating poor prognostic patients with targeted therapy.


  1. Flores RJ. The use of circulating SAA and CXCL4 to predict outcome of osteosarcoma at diagnosis. Poster presentation at: AACR Annual Meeting 2016; April 16-20, 2016; New Orleans, LA.