Neoadjuvant chemotherapy followed by limb-sparing surgery for osteosarcoma: a retrospective cohort study on efficacy,...

This retrospective study evaluated the outcomes of neoadjuvant chemotherapy (NACT) combined with limb-sparing surgery (LSS) for osteosarcoma (OS). A total of 204 OS patients treated at West China Hospital, Sichuan University between February 2020 and February 2023 were enrolled. Based on treatment modalities, patients were assigned to a control group (n=100; undergoing LSS) and an observation group (n=104; receiving NACT+LSS). Comparative analyses were performed to assess clinical outcomes, safety, inflammatory markers (C-reactive protein [CRP], tumor necrosis factor [TNF]-α), tumor-associated biomarkers (carcinoembryonic antigen [CEA], serum alkaline phosphatase [ALP], lactate dehydrogenase [LDH]), humoral immunity indicators (immunoglobulin [Ig] A/M/G), and 3-year prognosis (including metastasis and survival). Univariate and multivariate binary logistic regression analyses were conducted to identify independent determinants of therapeutic responses. Compared with the control group, the observation group demonstrated notably superior overall response and 3-year survival rates, while the overall incidence of adverse events was comparable, with no significant increase in severe adverse reactions. After intervention, both groups exhibited significant reductions in CRP, TNF-α, CEA, ALP, LDH, and IgA/M/G levels, with the observation group showing lower CRP, TNF-α, CEA, ALP, and LDH and higher IgA/M/G than the control group. Additionally, the 3-year incidence of lung metastasis was significantly lower in the observation group. Multivariate regression analysis identified maximum tumor diameter ≥7.8 cm, LSS alone, and elevated CEA as independent risk factors for poor treatment response, while increased IgA levels emerged as an independent protective factor. These results support the clinical benefit of NACT combined with LSS in OS, without increasing the risk of adverse events or severe specific adverse reactions.