Abstract
Background: This study aimed to construct a clinical prediction model for osteosarcoma patients to evaluate the influence factors for the occurrence of lymph node metastasis (LNM).Methods: In our retrospective study, a total of 1,256 patients diagnosed with chondrosarcoma were enrolled from the SEER (Surveillance, Epidemiology, and End Results) database (training cohort, n = 1,144) and multicenter dataset (validation cohort, n = 112). Both the univariate and multivariable logistic regression analysis were performed to identify the potential risk factors of LNM in osteosarcoma patients. According to the results of multivariable logistic regression analysis, A nomogram were established and the predictive ability was assessed by calibration plots, receiver operating characteristics (ROCs) curve, and decision curve analysis (DCA). Moreover, Kaplan-Meier plot of overall survival (OS) was plot and a web calculator visualized the nomogram.Results: Five independent risk factors [chemotherapy, surgery, lung metastases, lymphatic metastases (M-stage) and tumor size (T-stage)] were identified by multivariable logistic regression analysis. What's more, calibration plots displayed great power both in training and validation group. DCA presented great clinical utility. ROCs curve provided the predictive ability in the training cohort (AUC = 0.805) and the validation cohort (AUC = 0.808). Moreover, patients in LNN group had significantly better survival than that in LNP group both in training and validation group.Conclusion: In this study, we constructed and developed a nomogram with risk factors, which performed well in predicting risk factors of LNM in osteosarcoma patients. It may give a guide for surgeons and oncologists to optimize individual treatment and make a better clinical decision.
Highlights
Osteosarcoma is a common malignant bone tumor
The study was approved by the ethics review committee of four medical institutions in China, the Second Affiliated Hospital of Abbreviations: SEER, Surveillance, Epidemiology, and End Results database; ROC, receiver operating characteristic; DCA, decision curve analysis; CI, confidence interval; area under the curves (AUC), area under the curve; LNN, lymph node negative; LNM, lymph node metastases; ICD, International Classification of Diseases; SD, standard deviation; KM curves, Kaplan-Meier curves; OR, odds ratio
There were no significant differences in race, sex, laterality and radiation between the lymph node negative group (LNN, n = 1,104) and the lymph node positive group (LNP, n = 152)
Summary
Osteosarcoma is a common malignant bone tumor. The primary treatment consisting of neoadjuvant therapy, surgery and postoperative chemotherapy have resulted in the 5-year overall survival rate of ∼60% [1, 2]. Even with the treatment of surgery and chemotherapy, the prognosis for patients with metastatic osteosarcoma remains dismal [3, 4].The lung metastases, the primary target of metastasis in osteosarcoma, has five-year survival rates of ∼30% [5, 6]. Patients with lymph node metastases (LNM) have worse clinical outcomes, with fiveyear survival rates of 10% [7]. As a visual prediction tool, nomogram lists each variable separately and assigns a corresponding score for each status [19] Based on these considerations, we mined the Surveillance, Epidemiology, and End Results (SEER) database to construct the nomogram and used data from four academic hospitals for independent validation. This study aimed to construct a clinical prediction model for osteosarcoma patients to evaluate the influence factors for the occurrence of lymph node metastasis (LNM)
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