Development and Validation of a Prognostic Model for Overall Survival in Patients with Primary Pelvis and Spine Osteosarcoma: A Population-Based Study and External Validation

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Apr 13

PMID 37048606

Authors

Da Wang

Fanrong Liu

Binbin Li

Jinhui Xu

Haiyi Gong

Minglei Yang

Wei Wan

Jian Jiao

Yujie Liu

Jianru Xiao

Affiliations

Soon will be listed here.

Abstract

Background: Primary pelvis and spine osteosarcoma (PSOS) is a specific type of osteosarcoma that is difficult to treat and has a poor prognosis. In recent years, the research on osteosarcoma has been increasing, but there have been few studies on PSOS; in particular, there have been a lack of analyses with a large sample size. This study aimed to construct and validate a model to predict the overall survival (OS) of PSOS patients, as currently there are no tools available for assessing their prognosis.

Methods: Data including demographic information, clinical characteristics, and follow-up information on patients with PSOS were collected from the Surveillance, Epidemiology, and End Results (SEER) database, as well as from the Spine Tumor Center of Changzheng Hospital. Variable selection was achieved through a backward procedure based on the Akaike Information Criterion (AIC). Prognostic factors were identified by univariate and multivariate Cox analysis. A nomogram was further constructed for the estimation of 1-, 3-, and 5-year OS. Calibration plots, the concordance index (C-index), and the receiver operating characteristic (ROC) were used to evaluate the prediction model.

Results: In total, 83 PSOS patients and 90 PSOS patients were separately collected from the SEER database and Changzheng Hospital. In the SEER cohort, liver metastasis, lung metastasis, and chemotherapy were recognized as independent prognostic factors for OS ( < 0.05) and were incorporated to construct the initial nomogram. However, the initial nomogram showed poor predictive accuracy in internal and external validation. Then, we shifted our focus to the Changzheng data. Lung metastasis involving segments, Eastern Cooperative Oncology Group (ECOG) performance score, alkaline phosphatase (ALP) level, and en bloc resection were ultimately identified as independent prognostic factors for OS ( < 0.05) and were further incorporated to construct the current nomogram, of which the bias-corrected C-index was 0.834 (0.824-0.856). The areas under the ROC curves (AUCs) of the current nomogram regarding 1-, 3-, and 5-year OS probabilities were 0.93, 0.96, and 0.92, respectively.

Conclusion: We have developed a predictive model with satisfactory performance and clinical practicability, enabling effective prediction of the OS of PSOS patients and aiding clinicians in decision-making.

Citing Articles

Nomograms to predict lung metastasis in malignant primary osseous spinal neoplasms and cancer-specific survival in lung metastasis subgroup.

Jiang Y, Zhu Y, Ding Y, Lu X Front Oncol. 2024; 14:1393990.

PMID: 39228988 PMC: 11368787. DOI: 10.3389/fonc.2024.1393990.

References

Picci P, Sangiorgi L, Rougraff B, Neff J, Casadei R, Campanacci M . Relationship of chemotherapy-induced necrosis and surgical margins to local recurrence in osteosarcoma. J Clin Oncol. 1994; 12(12):2699-705. DOI: 10.1200/JCO.1994.12.12.2699. View

Fahey M, Spanier S, Vander Griend R . Osteosarcoma of the pelvis. A clinical and histopathological study of twenty-five patients. J Bone Joint Surg Am. 1992; 74(3):321-30. View

Hu T, Wang S, Huang L, Wang J, Shi D, Li Y . A clinical-radiomics nomogram for the preoperative prediction of lung metastasis in colorectal cancer patients with indeterminate pulmonary nodules. Eur Radiol. 2018; 29(1):439-449. DOI: 10.1007/s00330-018-5539-3. View

Cates J . Simple staging system for osteosarcoma performs equivalently to the AJCC and MSTS systems. J Orthop Res. 2018; 36(10):2802-2808. DOI: 10.1002/jor.24032. View

Kun-Peng Z, Xiao-Long M, Chun-Lin Z . Overexpressed circPVT1, a potential new circular RNA biomarker, contributes to doxorubicin and cisplatin resistance of osteosarcoma cells by regulating ABCB1. Int J Biol Sci. 2018; 14(3):321-330. PMC: 5859477. DOI: 10.7150/ijbs.24360. View

Lefebvre G, Renaud A, Rocourt N, Cortet B, Ceugnart L, Cotten A . Primary vertebral osteosarcoma: five cases. Joint Bone Spine. 2013; 80(5):534-7. DOI: 10.1016/j.jbspin.2013.04.003. View

Zils K, Bielack S, Wilhelm M, Werner M, Schwarz R, Windhager R . Osteosarcoma of the mobile spine. Ann Oncol. 2013; 24(8):2190-5. DOI: 10.1093/annonc/mdt154. View

van den Hoven I, van Klaveren D, Verheuvel N, van la Parra R, Voogd A, de Roos W . Predicting the extent of nodal involvement for node positive breast cancer patients: Development and validation of a novel tool. J Surg Oncol. 2019; 120(4):578-586. PMC: 6771524. DOI: 10.1002/jso.25644. View

Ilaslan H, Sundaram M, Unni K, Shives T . Primary vertebral osteosarcoma: imaging findings. Radiology. 2004; 230(3):697-702. DOI: 10.1148/radiol.2303030226. View

10.

Barwick K, Huvos A, Smith J . Primary osteogenic sarcoma of the vertebral column: a clinicopathologic correlation of ten patients. Cancer. 1980; 46(3):595-604. DOI: 10.1002/1097-0142(19800801)46:3<595::aid-cncr2820460328>3.0.co;2-8. View

11.

Han J, Yong B, Luo C, Tan P, Peng T, Shen J . High serum alkaline phosphatase cooperating with MMP-9 predicts metastasis and poor prognosis in patients with primary osteosarcoma in Southern China. World J Surg Oncol. 2012; 10:37. PMC: 3305572. DOI: 10.1186/1477-7819-10-37. View

12.

Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T . Surgical strategy for spinal metastases. Spine (Phila Pa 1976). 2001; 26(3):298-306. DOI: 10.1097/00007632-200102010-00016. View

13.

ENNEKING W, Spanier S, Goodman M . A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980; (153):106-20. View

14.

Jawad M, Haleem A, Scully S . Malignant sarcoma of the pelvic bones: treatment outcomes and prognostic factors vary by histopathology. Cancer. 2011; 117(7):1529-41. DOI: 10.1002/cncr.25684. View

15.

Chen L, Liu X, Li M, Wang S, Zhou H, Liu L . A novel model to predict cancer-specific survival in patients with early-stage uterine papillary serous carcinoma (UPSC). Cancer Med. 2019; 9(3):988-998. PMC: 6997089. DOI: 10.1002/cam4.2648. View

16.

Schwab J, Gasbarrini A, Bandiera S, Boriani L, Amendola L, Picci P . Osteosarcoma of the mobile spine. Spine (Phila Pa 1976). 2012; 37(6):E381-6. DOI: 10.1097/BRS.0b013e31822fb1a7. View

17.

Demura S, Kato S, Shinmura K, Yokogawa N, Shimizu T, Handa M . Perioperative complications of total en bloc spondylectomy for spinal tumours. Bone Joint J. 2021; 103-B(5):976-983. DOI: 10.1302/0301-620X.103B5.BJJ-2020-1777.R1. View

18.

McGirt M, Ziya L Gokaslan , Chaichana K . Preoperative grading scale to predict survival in patients undergoing resection of malignant primary osseous spinal neoplasms. Spine J. 2011; 11(3):190-6. DOI: 10.1016/j.spinee.2011.01.013. View

19.

Boriani S, Bandiera S, Donthineni R, Amendola L, Cappuccio M, De Iure F . Morbidity of en bloc resections in the spine. Eur Spine J. 2009; 19(2):231-41. PMC: 2899819. DOI: 10.1007/s00586-009-1137-z. View

20.

Mukherjee D, Chaichana K, Ziya L Gokaslan , Aaronson O, Cheng J, McGirt M . Survival of patients with malignant primary osseous spinal neoplasms: results from the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2003. J Neurosurg Spine. 2010; 14(2):143-50. DOI: 10.3171/2010.10.SPINE10189. View