Biomarkers for Prognosis in Osteosarcoma: From Molecular Signatures to Clinical Applications

Osteosarcoma is an aggressive malignancy with a 5-year survival below 30% in metastatic disease, highlighting the need for prognostic tools. A review of 93 studies identified consistent prognostic biomarkers. p53 overexpression was associated with reduced overall and disease-free survival, while high Ki-67 correlated with advanced stage, metastasis, and poor outcomes. HER2 positivity increased metastatic risk. HIF-1α, VEGF, and MMP-9 predicted inferior survival. MYC amplification, TP53/RB1 disruption, and loss of H4K20me3 indicated worse prognosis. Epigenetic signatures predicted chemotherapy sensitivity. Non-coding RNAs showed strong prognostic value, with lncRNA models achieving AUCs 0.88. CircRNAs, metabolomic markers, and 18 F-FDG PET/CT metrics refined risk stratification.