Analysis of hsp27 and the autophagy marker LC3B þ puncta following preoperative chemotherapy identifies high-risk osteosarcoma patients

Document Type


Publication Date



Chemotherapy-induced autophagy is a proposed mechanism of chemoresistance and potential therapeutic target in osteosarcoma. We evaluated heat shock protein 27 (HSP27) and autophagy-related proteins as predictors of pathologic treatment response and prognostic markers among osteosarcoma patients who received standard chemotherapy. We analyzed 394 tumor specimens (pre-treatment, post-treatment, and metastases) from 260 osteosarcoma patients by immunohistochemistry for cytoplasmic light chain 3B (LC3B)-positive puncta, sequestosome 1 (SQSTM1), high mobility group box 1 (HMGB1), and HSP27 expression. The staining percentage and intensity for each marker were scored and the extent to which marker expression was correlated with pathologic response, relapse-free survival (RFS), and overall survival (OS) was assessed. LCB3 þ puncta in post-treatment primary tumors (50%) and metastases (67%) was significantly higher than in pre-treatment biopsy specimens (30%; P ¼ 0.023 and <0.001). Among 215 patients with localized osteosarcoma, both pretreatment [multivariate hazard ratio (HR), 26.7; 95% confidence interval (CI), 1.47–484; P ¼ 0.026] and post-treatment HSP27 expression (multivariate HR, 1.85; 95% CI, 1.03–3.33; P ¼ 0.039) were associated with worse OS. Lack of LC3B þ puncta at resection was an independent poor prognostic marker in both univariate (HR, 1.78; 95% CI, 1.05–3.03; P ¼ 0.034) and multivariate models (HR, 1.75; 95% CI, 1.01–3.04; P ¼ 0.045). Patients with LC3B þ / HSP27 tumors at resection had the best 10-year OS (75%) whereas patients with LC3B/HSP27 þ tumors had the worst 10-year survival (25%). Neither HSP27 expression nor the presence of LCB3 þ puncta was correlated with pathologic treatment response. Our findings establish HSP27 expression and LC3B þ puncta as independent prognostic markers in osteosarcoma patients receiving standard chemotherapy and support further investigation into strategies targeting HSP27 or modulating autophagy in osteosarcoma treatment.