Increased Six1 expression is associated with poor prognosis in patients with osteosarcoma

Sine oculis homeobox homolog 1 (Six1) is an evolutionarily conserved transcription factor that acts as master regulator of development and is frequently dysregulated in various types of cancer. Six1 has been demonstrated to be upregulated in human osteosarcoma cell lines compared with osteoblastic cell lines. However, the association of Six1 expression with the progression and prognosis of osteosarcoma patients remains unclear. The purpose of the present study was to investigate the association between Six1 expression and the clinicopathological characteristics and prognosis of osteosarcoma. Six1 protein was detected by immunohistochemistry in a series of 100 osteosarcoma patients, and Kaplan-Meier survival analysis was performed to assess prognosis. The results revealed that increased Six1 protein expression was prevalent in osteosarcoma and was significantly associated with Enneking stage (P=0.002) and tumor size (P=0.010). Additionally, according to the log-rank test and Cox regression model, expression of Six1 is indicated to be an independent prognostic factor in osteosarcoma patients. In summary, positive expression of Six1 protein is closely associated with the tumor progression and poor survival of osteosarcoma patients. The results suggest that Six1 is a overexpressed in individuals with poor prognosis, and may thus be used as a prognostic biomarker in patients with osteosarcoma.