Formulation and validation of a baseline prognostic score for osteosarcoma treated uniformly with a non-high dose methotrexate-based protocol from a low middle income healthcare setting: a single centre analysis of 594 patients

Frontiers in Oncology

Oncology

Sameer Bakhshi¹  Deepam Pushpam¹  Shuvadeep Ganguly¹  Archana Sasi¹  Shah Alam Khan²  Love Kapoor²  Venkatesan Sampath Kumar²  Adarsh Barwad³  Mehar Chand Sharma³  Asit Mridha³  Sanjay Thulkar⁴ 

[1] Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India;Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India;Department of Pathology, All India Institute of Medical Sciences, New Delhi, India;Department of Radiodiagnosis, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India;

关键词: prognostic;    score;    osteosarcoma;    low middle income countries;    bone sarcoma;   

DOI  :  10.3389/fonc.2023.1148480

 received in 2023-01-20, accepted in 2023-04-05,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe outcomes of osteosarcoma in low middle income countries (LMICs) are different due to patients presenting in advanced stages, resource constraints and the use of non-high-dose-methotrexate (HDMTX)-based regimens. This study derived and validated a prognostic score for osteosarcoma that integrates biologic and social factors and is tailored for patients from an LMIC setting using a non-HDMTX-based protocol.Materials and methodsA retrospective study including osteosarcoma patients enrolled for treatment at a single tertiary care centre in India between 2003-19 was conducted. Baseline biologic and social characteristics were extracted from medical records and survival outcomes were noted. The cohort was randomised into a derivation and validation cohort. Multivariable Cox regression was used to identify baseline characteristics that were independently prognostic for survival outcomes in the derivation cohort. A score was derived from the prognostic factors identified in the derivation cohort and further validated in the validation cohort with estimation of its predictive ability.Results594 patients with osteosarcoma were eligible for inclusion in the study. Around one-third of the cohort had metastatic disease with 59% of the patients residing in rural areas. The presence of metastases at baseline (HR 3.39; p<0.001; score=3), elevated serum alkaline phosphatase (SAP) >450 IU/L (HR 1.57; p=0.001; score=1) and baseline tumour size > 10 cm (HR 1.68; p<0.001; score=1) were identified to be independent factors predicting inferior event free survival (EFS) and were included in development of the prognostic score. Patients were categorized as low risk (score 0), intermediate risk (score 1-3) and high risk (4-5). Harrell’s c-indices for the score were 0.682, 0.608 and 0.657 respectively for EFS in the derivation, validation and whole cohort respectively. The timed AUC of ROC was 0.67 for predicting 18-month EFS in the derivation, validation and whole cohorts while that for 36-month EFS were 0.68, 0.66 and 0.68 respectively.ConclusionsThe study describes the outcomes among osteosarcoma patients from an LMIC treated uniformly with a non-HDMTX-based protocol. Tumor size, baseline metastases and SAP were prognostic factors used to derive a score with good predictive value for survival outcomes. Social factors did not emerge as determinants of survival.

【 授权许可】

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Copyright © 2023 Ganguly, Sasi, Khan, Kumar, Kapoor, Sharma, Mridha, Barwad, Thulkar, Pushpam and Bakhshi