Univariate analysis revealed that pathological fracture (HR = 2.006 (1.081–3.953), P = 0.044), initial CT report (HR = 2.291 (1.398–3.756), P = 0.001, NLR (HR = 2.182 (1.331–3.578), P = 0.002), PLR (HR = 2.289 (1.363–3.845), P = 0.002), ALP (HR = 2.189 (1.316–3.640), P = 0.003), and LIPI (HR = 2.283 (1.564–3.331), P = 1.86e−05) were all significantly associated with osteosarcoma metastasis (Figure 3A). The gene discussed is LIPI; the disease is osteosarcoma.