Department of Urology, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
Department of Urology, Kunming Children's Hospital (Children's Hospital Affiliated to Kunming Medical University), Yunnan Key Laboratory of Children's Major Disease Research, Kunming, China.
Front Public Health. 2022 Feb 1;10:837506. doi: 10.3389/fpubh.2022.837506. eCollection 2022.
Osteosarcoma (OSC) and Ewing's sarcoma (EWS) are children's most common primary bone tumors. The purpose of the study is to develop and validate a new nomogram to predict the cancer-specific survival (CSS) of childhood OSC and EWS.
The clinicopathological information of all children with OSC and EWS from 2004 to 2018 was downloaded from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression analyses were used to screen children's independent risk factors for CSS. These risk factors were used to construct a nomogram to predict the CSS of children with OSC and EWS. A series of validation methods, including calibration plots, consistency index (C-index), and area under the receiver operating characteristic curve (AUC), were used to validate the accuracy and reliability of the prediction model. Decision curve analysis (DCA) was used to validate the clinical application efficacy of predictive models. All patients were divided into low- and high-risk groups based on the nomogram score. Kaplan-Meier curve and log-rank test were used to compare survival differences between the two groups.
A total of 2059 children with OSC and EWS were included. All patients were randomly divided into training cohort 60% ( = 1215) and validation cohort 40% ( = 844). Univariate and multivariate analysis suggested that age, surgery, stage, primary site, tumor size, and histological type were independent risk factors. Nomograms were established based on these factors to predict 3-, 5-, and 8-years CSS of children with OSC and EWS. The calibration plots showed that the predicted value was highly consistent with the actual value. In the training cohort and validation cohort, the C-index was 0.729 (0.702-0.756) and 0.735 (0.702-0.768), respectively. The AUC of the training cohort and the validation cohort also showed similar results. The DCA showed that the nomogram had good clinical value.
We constructed a new nomogram to predict the CSS of OSC and EWS in children. This predictive model has good accuracy and reliability and can help doctors and patients develop clinical strategies.
骨肉瘤（OSC）和尤因肉瘤（EWS）是儿童最常见的原发性骨肿瘤。本研究旨在开发和验证一种新的列线图，以预测儿童骨肉瘤和尤因肉瘤的癌症特异性生存（CSS）。
从监测、流行病学和最终结果（SEER）数据库中下载了 2004 年至 2018 年所有儿童 OSC 和 EWS 的临床病理信息。使用单因素和多因素 Cox 回归分析筛选儿童 CSS 的独立危险因素。这些危险因素被用来构建一个列线图来预测儿童骨肉瘤和尤因肉瘤的 CSS。使用一系列验证方法，包括校准图、一致性指数（C-index）和接收者操作特征曲线下的面积（AUC），来验证预测模型的准确性和可靠性。决策曲线分析（DCA）用于验证预测模型的临床应用效果。根据列线图评分将所有患者分为低风险组和高风险组。Kaplan-Meier 曲线和对数秩检验用于比较两组之间的生存差异。
共纳入 2059 例儿童 OSC 和 EWS。所有患者被随机分为训练队列 60%（n=1215）和验证队列 40%（n=844）。单因素和多因素分析表明，年龄、手术、分期、原发部位、肿瘤大小和组织学类型是独立的危险因素。基于这些因素建立了列线图，以预测儿童骨肉瘤和尤因肉瘤 3、5 和 8 年 CSS。校准图显示预测值与实际值高度一致。在训练队列和验证队列中，C-index 分别为 0.729（0.702-0.756）和 0.735（0.702-0.768）。训练队列和验证队列的 AUC 也显示出相似的结果。DCA 显示列线图具有良好的临床价值。
我们构建了一个新的列线图来预测儿童骨肉瘤和尤因肉瘤的 CSS。该预测模型具有良好的准确性和可靠性，有助于医生和患者制定临床策略。
