Abstract

BackgroundOsteosarcoma is the most common bone cancer, mainly occurring in children and adolescents, among which distant metastasis (DM) still leads to a poor prognosis. Although nomogram has recently been used in tumor areas, there are no studies focused on diagnostic and prognostic evaluation of DM in primary osteosarcoma patients.MethodsThe data of osteosarcoma patients diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for DM in osteosarcoma patients, and univariate and multivariate Cox proportional hazards regression analyses were used to determine independent prognostic factors of osteosarcoma patients with DM. We then established two novel nomograms and the results were evaluated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).ResultA total of 1,657 patients with osteosarcoma were included, and 267 patients (16.11%) had DM at the time of diagnosis. The independent risk factors for DM in patients with osteosarcoma include age, grade, T stage, and N stage. The independent prognostic factors for osteosarcoma patients with DM are age, chemotherapy and surgery. The results of ROC curves, calibration, DCA, and Kaplan–Meier (K-M) survival curves in the training, validation, and expanded testing sets, confirmed that two nomograms can precisely predict occurrence and prognosis of DM in osteosarcoma patients.ConclusionTwo nomograms are expected to be effective tools for predicting the risk of DM for osteosarcoma patients and personalized prognosis prediction for patients with DM, which may benefit clinical decision-making.

Highlights

  • Osteosarcoma is the most prevalent form of bone cancer and mainly occurs in children and adolescents [1], which is predominantly derived from the terminus of the long bones, including distal femur (43%), proximal tibias (23%), and proximal humor (10%) [2]

  • A total of 1,657 patients with osteosarcoma were enrolled, and 996 and 661 patients were stratified into the training and validation sets

  • Regarding the histological type of osteosarcoma patients, osteosarcoma, NOS accounted for 62.55% in the training set and 63.39% in the validation set

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Summary

Introduction

Osteosarcoma is the most prevalent form of bone cancer and mainly occurs in children and adolescents [1], which is predominantly derived from the terminus of the long bones, including distal femur (43%), proximal tibias (23%), and proximal humor (10%) [2]. Systemic chemotherapy combined with extensive surgical resection is recognized as the most effective treatment method for osteosarcoma [5,6,7], and the 5-year survival rate of non-metastatic osteosarcoma patients has been improved to 60–70% with multimodal therapy [8]. Osteosarcoma with distant metastasis (DM) still results in poor prognosis, and only 11– 30% of patients can survive with a multimodal combination of surgical resection and chemotherapy [9, 10]. Osteosarcoma is the most common bone cancer, mainly occurring in children and adolescents, among which distant metastasis (DM) still leads to a poor prognosis. Nomogram has recently been used in tumor areas, there are no studies focused on diagnostic and prognostic evaluation of DM in primary osteosarcoma patients

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