***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: One hundred thirty patients with high grade osteosarcoma were enrolled in a r and omized prospect i ve multidisciplinary treatment that included intraarterial chemotherapy , local irradiation , limb salvage surgery , and prophylactic whole lung irradiation . The patients were evaluated to stage the prognostic factors . In a multivariate analysis , a minimal level of serum lactic acid dehydrogenase less than 300 IU/L showed a significant prognostic value . The history of trauma before diagnosis of disease , local irradiation of the affected site , histologic response to preoperative multidisciplinary therapy , and prophylactic whole lung irradiation were associated with significantly better prognosis in the log rank test . Patient age , site of the primary tumor , presentation of fracture , pathologic subtype , signs and symptoms , serum alkaline phosphatase level , and erythrocyte sedimentation rate were not found to be prognostic factors . The 9-year survival rate of the whole group was 55 % 
    Output:
    
In this meta- analysis , elevated serum levels of alkaline phosphatase were associated with an increased risk of overall mortality and disease progression in patients with hormone-sensitive prostate cancer .
In contrast , those were not associated with an increased risk of cancer-specific mortality .
Alkaline phosphatase was independently associated with overall survival in both patients with “ high-volume ” and “ low-volume ” hormone-sensitive prostate cancer .