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. 2015 Nov 10;6(35):38348-59.
doi: 10.18632/oncotarget.5276.

Development and validation of a pretreatment prognostic index to predict death and lung metastases in extremity osteosarcoma

Bo Wang  1 , Jian Tu  1 , Junqiang Yin  1 , Changye Zou  1 , Jin Wang  1 , Gang Huang  1 , Xianbiao Xie  1 , Jingnan Shen  1
Affiliations

Development and validation of a pretreatment prognostic index to predict death and lung metastases in extremity osteosarcoma

Bo Wang et al. Oncotarget. .

Abstract

Background: To develop a prognostic index to predict the 5-year overall survival (OS) and 5-year lung metastasis-free survival (LMFS) of patients with extremity osteosarcoma at the time of diagnosis.

Methods: We retrospectively evaluated 454 patients with extremity osteosarcoma at our center from 2005 to 2013. The cohort was randomly divided into training and validation sets. The association of potential risk factors with OS and LMFS was assessed by Cox proportional hazards analysis in the training set, and a prognostic index was created according to scores that were proportional to a regression coefficient for each factor. This prognostic index was assessed in the validation set.

Results: For the 5-year OS, 5 independent prognostic factors were identified: tumor size, Enneking stage, pretreatment platelet, alkaline phosphatase(ALP), and neutrophils. The multivariate Cox model identified tumor size, pretreatment platelets, ALP, and neutrophils as associated with the 5-year LMFS. A prognostic index for death and lung metastases was calculated. Three risk groups were defined for each survival point: low, intermediate, and high risk for the 5-year OS; low, intermediate, and high risk for the 5-year LMFS. The C statistic for the 5-year OS was 0.723 in the training set and 0.710 in the validation set. The C statistic for the 5-year LMFS was 0.661 and 0.693 respectively.

Conclusions: This prognostic index is based on routine tests and characteristics of extremity osteosarcoma patients and is a useful predictor of OS and lung metastases. This index could be applied to clinical practice and trials for individualized risk-adapted therapies.

Keywords: lung metastases; osteosarcoma; pretreatment prognostic index; survival outcomes.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have disclosed no relevant financial relationship.

Figures

Figure 1
Figure 1. The chemotherapeutic agents and the treatment protocol of 454 patients
Figure 2
Figure 2. Flow chart for patients selection in this study
Figure 3
Figure 3
A. Kaplan-Meier curves showing the overall survival (OS) of the included patients. B. Kaplan-Meier curves showing the lung metastasis free survival (LMFS) of the included patients.
Figure 4
Figure 4. Kaplan-Meier Curves for Overall Survival (OS) in Training Set A. and Validation Set B
A. Eleven subgroups of development cohort merged to form three categories with significantly different prognoses. B. There were significant statistical differences on 5 year OS among the three categories of validation cohort, according to our prognostic classification.
Figure 5
Figure 5. Kaplan-Meier Curves for Lung Metastasis Free Survival (LMFS) in Training Set A. and Validation Set B
A. Five subgroups of development cohort merged to form three categories with significantly different prognoses. B. There were significant statistical differences on 5 year LMFS among the three categories of validation cohort, according to our prognostic classification.
See this image and copyright information in PMC

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