Cox regression analysis of the effect of ifosfamide and levamisole combination therapy on limb function and survival quality in osteosarcoma patients

Abstract

Purpose: To determine the effect of ifosfamide combined therapy on limb functionality and quality of life
in patients with osteosarcoma, utilizing Cox regression analysis to identify significant prognostic factors.
Methods: This was a prospective analysis conducted on 90 osteosarcoma patients admitted to
Shuguang Hospital, Shanghai, China between January 2021 and January 2023. Participants were
randomly assigned to study (n = 49) and control groups (n = 41). The study group received a
combination of ifosfamide (intravenously, 1.2 – 2.5 g/m2 of body surface area for 5 consecutive days
per treatment cycle) and levamisole (50 mg) and administered 2 to 3 times daily for three days every 2
weeks from the 7th day after surgery, while the control group received levamisole alone. Functional
outcome was assessed and compared using the Lysholm scoring scale, tumor necrosis factor-α (TNFα)
and C-reactive protein (CRP) levels, which served as inflammatory markers in both groups. Cox
regression analysis was used to identify survival predictors over a 180-day follow-up period.
Results: Lysholm scores in study group were significantly higher than in the control group (p < 0.05).
Furthermore, TNFα and CRP were significantly lower in the study group compared to the control group
(p < 0.05). There was a significant difference in the number of types of complications between both
groups (p < 0.05).
Conclusion: The combination of ifosfamide and levamisole significantly enhances lower limb
functionality, and decreases the incidence of complications in patients with osteosarcoma whose
prognosis is intricately linked to several key factors, such as tumor location, disease staging, and the
presence of complications. Further validation with larger sample sizes and multi-center studies is
required.