Abstract
Objective To develop an accurate prognostic nomogram for osteosarcoma and to validate it in order to provide scientific basis for risk evaluation, though analyzing the clinicopathologic, radiologic and follow-up data of osteosarcoma patients. Methods All of 235 osteosarcoma patients who diagnosed in the department of Musculoskeletal Oncology in the first affiliated hospital of Sun Yat-Sen University during 1998 to 2008 and met the inclusion criteria, were included in a primary cohort, and 55 patients diagnosed in 2009 were included in a validation cohort. In univariate survival analysis of the primary cohort, Kaplan-Meier method was used to plot Survival curves, and the log-rank test to compare differences. In the multivariate analysis, the Cox proportional hazard model had been used to identify the independent prognostic factors. Then a nomogram created by R software was validated by Bootstrap resampling as internal validation and by the validation cohort as external validation. Concordance index (C-index) was applied to the predictive evaluation of the nomogram and calibration curves were drawn to test the nomogram-prediction and actual observation of the five-year overall survival rate. Results The five-year over-all survival rates of the primary cohort and validation cohort were 46.1%±6.7% and 61.8%±12.9%, respectively. In multivariate analysis, pathologic fracture, pre-ALP, tumor maximum diameter, Enneking stage and postoperative chemotherapy had been identified as independent prognostic factors. Good concordance of survival probability between nomogram-prediction and actual observation was shown by the calibration curves. The C-index of the nomogram for predicting survival, 0.74(95% CI, 0.70-0.78), was statistically higher than that of the Enneking system (C-index: 0.54). Of the validation cohort, C-index of the nomogram, Enneking and American Joint Committee on Cancer (AJCC) stage system was 0.71, 0.54 and 0.56, respectively, indicating the nomogram had a higher accuracy in prognostic prediction than the others. Conclusion The nomogram as proposed is an effective tool for predicting the overall survival of osteosarcoma patients. Compared with Enneking and AJCC stage system, the nomogram was more accurate and visible. Key words: Osteosarcoma; Nomograms; Prognosis
Published Version
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