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. 2020 Mar;9(3):1604-1617.
doi: 10.21037/tcr.2020.01.56.

Clinical characteristics and prognostic factors of malignant fibrous histiocytoma of bone: a SEER population-based study

Lin Qi  1   2 , Chao Tu  1   2 , Xiaolei Ren  1   2 , Ruiqi Chen  1   2 , Lu Wan  1   2 , Chenghao Zhang  1   2 , Zhihong Li  1   2
Affiliations

Clinical characteristics and prognostic factors of malignant fibrous histiocytoma of bone: a SEER population-based study

Lin Qi et al. Transl Cancer Res. 2020 Mar.

Abstract

Background: Malignant fibrous histiocytoma of bone (MFH-B) is an extremely rare type of bone tumor. We aimed to analyze the clinical characteristics of MFH-B and establish nomograms that predict the prognosis of patients with MFH-B based on prognostic factors.

Methods: A total of 250 patients diagnosed with MFH-B were included from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves and log-rank tests were conducted. Potential prognostic factors were identified using univariate and multivariate Cox regression analysis. Nomograms that predict 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) were further developed and internally validated.

Results: The multivariate analysis suggested that OS of patients was associated with age ≥57 years [hazard ratio (HR), 1.916; 95% confidence interval (CI), 1.329-2.761; P<0.001], pelvic bones (HR, 1.742; 95% CI, 1.024-2.961; P=0.040) and other tumor sites (HR, 2.498; 95% CI, 1.515-4.120; P<0.001), Grade III/IV (HR, 1.750; 95% CI, 1.002-3.056; P=0.049), distant tumor stage (HR, 2.100; 95% CI, 1.351-3.263; P=0.001), tumor size ≥66 mm (HR, 2.629; 95% CI, 1.747-3.959; P<0.001) and no surgery (HR, 2.134; 95% CI, 1.380-3.300; P=0.001). We then developed nomograms based on the prognostic factors. The concordance index (C-index) of nomograms for OS and CSS were 0.74 (95% CI, 0.70-0.77) and 0.74 (95% CI, 0.70-0.78). Calibration plots suggested optimal concordance between the predictive outcomes of nomograms with the actual survival.

Conclusions: This is the first sizable study that analyzed clinical characteristics and prognostic factors of MFH-B. The nomograms we established for MFH-B were effective tools to predict prognosis of individual patients. These tools can also help doctors identify mortality risk.

Keywords: Malignant fibrous histiocytoma (MFH); Surveillance, Epidemiology, and End Results program (SEER program); nomogram; prognosis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tcr.2020.01.56). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Identification of optimal cut-off points of age at diagnosis (A,B,C) and tumor size (D,E,F) by the X-tile. (A,D) The cut-off points of age at diagnosis and tumor size were determined by the software with the black dots; histograms (B,E) and Kaplan-Meier curves (C,F) were established according to the cut-off points determined. Optimal cut-off points of age at diagnosis and tumor size were 57 years and 66 mm, respectively.
Figure 2
Figure 2
Study design. Data of patients with a histologically confirmed diagnosis of MFH-B were extracted from the SEER database (1975–2016), and then were analyzed according to the study design. MFH-B, malignant fibrous histiocytoma of bone; SEER, Surveillance Epidemiology and End Results.
Figure 3
Figure 3
Nomograms predicting 3- and 5-year OS (A) and 3- and 5-year CSS (B) of patients with MFH-B. Prognostic factors including age at diagnosis, tumor site, tumor grade, tumor stage, tumor size and surgical treatment had corresponding scores in nomograms. The 3- and 5-year OS rate and CSS rate could be predicted by adding up scores for each factor and connecting to specific survival rate based on the total scores. OS, overall survival; CSS, cancer-specific survival.
Figure 4
Figure 4
Internal validation of nomograms to predict OS and CSS. Discrimination: the AUC of the nomograms for 3-year OS (A), 5-year OS (C), 3-year CSS (E) and 5-year CSS (G) were 0.803, 0.810, 0.794 and 0.812, accordingly. Calibration: the calibration plots of the nomograms for 3-year OS (B), 5-year OS (D), 3-year CSS (F) and 5-year CSS (H). OS, overall survival; CSS, cancer-specific survival; AUC, areas under the curve.
Figure S1
Figure S1
Kaplan-Meier curves of OS in different groups of age at diagnosis (A), tumor site (B), tumor grade (C), tumor stage (D), tumor size (E) and surgical treatment (F). OS, overall survival.
Figure S2
Figure S2
Kaplan-Meier curves of CSS in different groups of tumor site (A), tumor grade (B), tumor stage (C), tumor size (D) and surgical treatment (E). CSS, cancer-specific survival.
Figure S3
Figure S3
Kaplan-Meier curves of OS (A) and CSS (B) in patients treated with limb salvage and amputation. OS, overall survival; CSS, cancer-specific survival.
Figure S4
Figure S4
Kaplan-Meier curves of OS (A) and CSS (B) before and after 2000. OS, overall survival; CSS, cancer-specific survival.
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