Abstract
BackgroundThe study aimed to build and validate practical nomograms to predict overall survival (OS) and cancer-specific survival (CSS) for patients with synovial sarcoma (SyS).MethodsA total of 893 eligible patients confirmed to have SyS between 2007 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly divided into the training cohort (n = 448) and validation cohort (n = 445). Clinically independent prognostic and important factors were determined according to the Akaike information criterion in multivariate Cox regression models when developing the nomograms with the training cohort. The predictive accuracy of nomograms was bootstrapped validated internally and externally with the concordance index (C-index) and calibration curve. Decision curve analysis (DCA) was performed to compare the clinical usefulness between nomograms and American Joint Commission on Cancer (AJCC) staging system.ResultsTwo nomograms shared common indicators including age, insurance status, tumor site, tumor size, SEER stage, surgery, and radiation, while marital status and tumor site were only included into the OS nomogram. The C-index of nomograms for predicting OS and CSS was 0.819 (0.873–0.764) and 0.821 (0.876–0.766), respectively, suggesting satisfactory predictive performance. Internal and external calibration curves exhibited optimal agreement between the nomogram prediction and the actual survival. Additionally, DCA demonstrated that our nomograms had obvious superiority over the AJCC staging system with more clinical net benefits.ConclusionsTwo nomograms predicting 3- and 5-year OS and CSS of SyS patients were successfully constructed and validated for the first time, with higher predictive accuracy and clinical values than the AJCC staging system regarding OS and CSS.
Highlights
Synovial sarcoma (SyS) is a rare malignancy that most commonly occurs in adolescents and young adults, accounting for about 6%–9% of the soft tissue sarcomas [1]
A growing number of studies have demonstrated that several other factors such as age, race, tumor site and size, and non-biological factors have an obvious impact on the prognosis of synovial sarcoma (SyS) patients
A total of 893 eligible SyS patients diagnosed between 2007 and 2015 in the SEER database were included in our analysis
Summary
Synovial sarcoma (SyS) is a rare malignancy that most commonly occurs in adolescents and young adults, accounting for about 6%–9% of the soft tissue sarcomas [1]. SySs have always been considered high-grade with particular molecular mechanism and poor prognosis [3]. Due to its lower incidence, most analyses of clinical characteristics and outcome for this disease are mainly from retrospective reviews in a single center with few prospective studies available, leading to a poor understanding of this tumor. Tumor-node-metastasis (TNM) staging system of the American Joint Commission on Cancer (AJCC) has long been a generally accepted formula for predicting prognosis of malignancies and represents the gold standard classification method for SyS [4]. The current AJCC staging system roughly divided patients into various groups but fails to evaluate the individualized survival based on patients’ demographic and clinical characteristics. The study aimed to build and validate practical nomograms to predict overall survival (OS) and cancer-specific survival (CSS) for patients with synovial sarcoma (SyS)
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