Postoperative nomogram to predict the probability of metastasis in Enneking stage IIB extremity osteosarcoma

BMC Cancer

Woo-Ick Yang⁵  Jin-Suck Suh³  Jae Kyoung Noh⁴  Yong Jin Cho²  Ha Yan Kim¹  Kyoo-Ho Shin²  Seung Hyun Kim² 

[1]Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea

[2]Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul, Korea

[3]Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea

[4]Cancer Center, Yonsei University College of Medicine, Seoul, Korea

[5]Department of Pathology, Yonsei University College of Medicine, Seoul, Korea

关键词: Dichotomous outcomes;    Nomogram;    Metastasis;    Osteosarcoma;   

Others  :  1121087
DOI  :  10.1186/1471-2407-14-666

 received in 2014-05-08, accepted in 2014-09-09,  发布年份 2014

【 摘 要 】

Background

Metastasis is the most crucial prognostic factor in osteosarcoma. The goal of this study was to develop a new nomogram to predict the probability of metastasis in Enneking stage IIB extremity osteosarcoma after neoadjuvant chemotherapy and limb salvage surgery.

Methods

We examined medical records of 91 patients who had undergone surgery between March 1994 and March 2007. A nomogram was developed using multivariate logistic regression. The nomogram was validated internally by bootstrapping-method (200 repetitions) and externally in independent validation set (n = 34). A Youden-derived cutoff value was assigned to the nomogram to predict dichotomous outcomes for metastasis.

Results

The nomogram was built from four predictors of tumor site, serum alkaline phosphatase, intracapsular extension, and Huvos grade, and an additional clause that the cutoff value should be added to the total points in the cases of incomplete surgical resection. P-value of Hosmer and Lemshow Goodness-of-fit test of this model was 0.649. Area under receiver operating curve values of 0.83 (95% confidence interval [CI], 0.75 to 0.92) in the training set and 0.80 (95% CI, 0.63 to 0.96) in the validation set were obtained. The accuracy of dichotomous outcomes was 79.1% (95% CI, 0.69 to 0.86) and 82.4% (95% CI, 0.63 to 0.92) in the training and validation sets.

Conclusions

We have developed a new high-performance nomogram to predict the probability of metastasis in Enneking stage IIB extremity osteosarcoma after limb salvage surgery.

【 授权许可】

   
2014 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Jeon DG, Song WS: How can survival be improved in localized osteosarcoma? Expert Rev Anticancer Ther 2010, 10(8):1313-1325.
• [2]Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980, 153:106-120.
• [3]Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (Eds): AJCC Cancer Staging Manual. 7th edition. New York: Springer-Verlag; 2010.
• [4]Hagleitner MM, Hoogerbrugge PM, van der Graaf WT, Flucke U, Schreuder HW, te Loo DM: Age as prognostic factor in patients with osteosarcoma. Bone 2011, 49(6):1173-1177.
• [5]Mankin HJ, Hornicek FJ, Rosenberg AE, Harmon DC, Gebhardt MC: Survival data for 648 patients with osteosarcoma treated at one institution. Clin Orthop Relat Res 2004, 429:286-291.
• [6]Meyers PA, Heller G, Healey J, Huvos A, Lane J, Marcove R, Applewhite A, Vlamis V, Rosen G: Chemotherapy for nonmetastatic osteogenic sarcoma: the Memorial Sloan-Kettering experience. J Clin Oncol 1992, 10(1):5-15.
• [7]Cho WH, Song WS, Jeon DG, Kong CB, Kim MS, Lee JA, Yoo JY, Kim JD, Lee SY: Differential presentations, clinical courses, and survivals of osteosarcomas of the proximal humerus over other extremity locations. Ann Surg Oncol 2010, 17(3):702-708.
• [8]Bacci G, Picci P, Ferrari S, Orlandi M, Ruggieri P, Casadei R, Ferraro A, Biagini R, Battistini A: Prognostic significance of serum alkaline phosphatase measurements in patients with osteosarcoma treated with adjuvant or neoadjuvant chemotherapy. Cancer 1993, 71(4):1224-1230.
• [9]Bacci G, Longhi A, Ferrari S, Briccoli A, Donati D, De Paolis M, Versari M: Prognostic significance of serum lactate dehydrogenase in osteosarcoma of the extremity: experience at Rizzoli on 1421 patients treated over the last 30 years. Tumori 2004, 90(5):478-484.
• [10]Kim MS, Lee SY, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Shin DS, Jeon DG: Growth patterns of osteosarcoma predict patient survival. Arch Orthop Trauma Surg 2009, 129(9):1189-1196.
• [11]Ferrari S, Bertoni F, Mercuri M, Picci P, Giacomini S, Longhi A, Bacci G: Predictive factors of disease-free survival for non-metastatic osteosarcoma of the extremity: an analysis of 300 patients treated at the Rizzoli Institute. Ann Oncol 2001, 12(8):1145-1150.
• [12]Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jurgens H, Winkler K: Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol 2002, 20(3):776-790.
• [13]Clark JC, Dass CR, Choong PF: A review of clinical and molecular prognostic factors in osteosarcoma. J Cancer Res Clin Oncol 2008, 134(3):281-297.
• [14]Iasonos A, Schrag D, Raj GV, Panageas KS: How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 2008, 26(8):1364-1370.
• [15]Kattan MW, Leung DH, Brennan MF: Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002, 20(3):791-796.
• [16]Chisholm JC, Marandet J, Rey A, Scopinaro M, de Toledo JS, Merks JH, O’Meara A, Stevens MC, Oberlin O: Prognostic factors after relapse in nonmetastatic rhabdomyosarcoma: a nomogram to better define patients who can be salvaged with further therapy. J Clin Oncol 2011, 29(10):1319-1325.
• [17]Kim MS, Lee SY, Lee TR, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Jeon DG: Prognostic nomogram for predicting the 5-year probability of developing metastasis after neo-adjuvant chemotherapy and definitive surgery for AJCC stage II extremity osteosarcoma. Ann Oncol 2009, 20(5):955-960.
• [18]Bielack SS, Kempf-Bielack B, Branscheid D, Carrle D, Friedel G, Helmke K, Kevric M, Jundt G, Kuhne T, Maas R, Schwarz R, Zoubek A, Jurgens H: Second and subsequent recurrences of osteosarcoma: presentation, treatment, and outcomes of 249 consecutive cooperative osteosarcoma study group patients. J Clin Oncol 2009, 27(4):557-565.
• [19]Hong S, Shin SJ, Jung M, Jeong J, Lee YJ, Shin KH, Roh JK, Rha SY: Comparison of long-term outcome between doublet and triplet neoadjuvant chemotherapy in non-metastatic osteosarcoma of the extremity. Oncology 2011, 80(1–2):107-117.
• [20]Bieling P, Rehan N, Winkler P, Helmke K, Maas R, Fuchs N, Bielack S, Heise U, Jurgens H, Treuner J, Romanowski R, Exner U, Kotz R, Winkler K: Tumor size and prognosis in aggressively treated osteosarcoma. J Clin Oncol 1996, 14(3):848-858.
• [21]Kim MS, Lee SY, Cho WH, Song WS, Koh JS, Lee JA, Yoo JY, Shin DS, Jeon DG: An examination of the efficacy of the 8 cm maximal tumor diameter cutoff for the subdivision of AJCC stage II osteosarcoma patients. J Surg Oncol 2008, 98(6):427-431.
• [22]Simon MA, Hecht JD: Invasion of joints by primary bone sarcomas in adults. Cancer 1982, 50(8):1649-1655.
• [23]Quan GM, Slavin JL, Schlicht SM, Smith PJ, Powell GJ, Choong PF: Osteosarcoma near joints: assessment and implications. J Surg Oncol 2005, 91(3):159-166.
• [24]Schima W, Amann G, Stiglbauer R, Windhager R, Kramer J, Nicolakis M, Farres MT, Imhof H: Preoperative staging of osteosarcoma: efficacy of MR imaging in detecting joint involvement. AJR Am J Roentgenol 1994, 163(5):1171-1175.
• [25]Bacci G, Longhi A, Versari M, Mercuri M, Briccoli A, Picci P: Prognostic factors for osteosarcoma of the extremity treated with neoadjuvant chemotherapy: 15-year experience in 789 patients treated at a single institution. Cancer 2006, 106(5):1154-1161.
• [26]Kim MS, Cho WH, Song WS, Lee SY, Jeon DG: Time dependency of prognostic factors in patients with stage II osteosarcomas. Clin Orthop Relat Res 2007, 463:157-165.