Prognostic Nomogram for Predicting 5-Year Overall Survival in Chinese Patients Under 30 Years of Age with High-Grade Osteosarcoma Using High-Dimensional Survival Data

Abstract

Background: This study purposed to construct a widely accepted prognostic nomogram in Chinese high-grade osteosarcoma (HOS) patients aged ≤ 30 years to provide insight into predicting 5-year overall survival (OS). Methods: Data of 503 consecutive HOS patients at our centre between 12/2012 and 05/2019 were retrospectively collected. The 84 clinical features, routine laboratory haematological and biochemical testing indicators of each patient at the time of diagnosis were collected. A prognostic nomogram model for predicting OS was constructed based on Cox proportional hazards model. The performance was assessed by concordance index (C-index), receiver operating characteristic curve and calibration curve. The utility was evaluated by decision curve analysis. Findings: The 5-year OS was 52.1% and 2.6% for the nonmetastatic and metastatic patients, respectively. The nomogram included nine important variables based on a multivariate analysis: tumour stage, surgical type, metastasis, preoperative neoadjuvant chemotherapy cycle, postoperative metastasis time, mean corpuscular volume, tumour-specific growth factor, gamma-glutamyl transferase and creatinine. The calibration curve showed that the nomogram was able to predict 5-year OS accurately. The C-index of the nomogram for OS prediction was 0.795 (range, 0.703-0.887). Moreover, the decision curve analysis curve also demonstrated the clinical benefit of this model. Interpretation: The nomogram provides an individualized risk estimate of the 5-year OS in patients with HOS aged ≤ 30 years in a Chinese population-based cohort. Funding Statement: This work was financially funded by the National Science Foundation of China (No. U1702283, 81972764, 81960488, 81760520, 81560471), the Joint Special Funds for the Department of Science and Technology of Yunnan Province-Kunming Medical University (No. 2017FE467-073, 2018FE001-060, 2019FE001-152, 2019FE001-078), the Scientific Research Projects of Internal Research Institutions of Medicine (Nos. 2017NS196, 2017NS197, 2018NS069, 2018NS070), the Medical Leaders of Yunnan Province (No. D-201603), the Foundation of the Young and Middle-aged Academic and Technical Leaders of Yunnan Province (No. 2017HB051), China Postdoctoral Science Foundation (No. 2018M643798XB), Training program for 100 Young and middle-aged Academic and technical backbones of Kunming Medical University and the Major Scientific and Technological Achievement Cultivation Project of Kunming Medical University (No. CGPY201703). Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: All human tissue experiments were approved by the Institutional Ethics Committee of the Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital). Written informed consent forms for the experimental studies were obtained from the patients or their guardians.