Xiao Zheng-Wei, Guo Hui-Ling, Chen Hong-Chao, Yan Lai-Peng, Liao Yi-Lin, Li Shu-Lin, Zhao Li-Lan, Su Ling-Bo, Li Jun-Jie, Tang Fa-Qiang
Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian Province, China.
Department of Orthopaedics, Fujian Provincial Hospital, Fuzhou, Fujian Province, China.
J Oncol. 2022 Mar 26;2022:9935439. doi: 10.1155/2022/9935439. eCollection 2022.
Bone metastasis (BM) has been proven to be responsible for the poor prognosis of primary malignant bone neoplasms (PMBNs). We aimed to identify the prevalence, risk factors, and prognostic factors for PMBNs patients with BM based on the Surveillance, Epidemiology, and End Results (SEER) database.
4,758 patients diagnosed with PMBNs from 2010 to 2018 were selected from the SEER database. All patients were divided into two groups: the BM group or the non-BM group. Pearson's chi-square test and Fisher's exact method were used to assess baseline characteristics, and logistic regression analysis was applied to assess risk factors. In addition, a nomogram was constructed based on the results of Cox regression analysis among 227 patients with BM. The good performance and clinical applicability of the nomogram were tested by the concordance index, operating characteristic curve, area under the curve, calibration curves, and decision curve analysis.
227 (4.8%) patients had metastasis to bone at diagnosis. Primary site outside the extremities (axial: odds ratio, OR = 1.770; others: OR = 1.951), Ewing sarcoma (OR = 2.845), larger tumor size (5-8 cm: OR = 3.403; >8 cm: OR = 5.562), tumor extension beyond the periosteum (OR = 2.477), and regional lymph node metastasis (OR = 2.900) were associated with a higher risk of BM at the initial diagnosis of PMBNs. Five independent prognostic factors were found in the survival analysis: pathological type (chondrosarcoma vs. osteosarcoma: hazard ratio, HR = 0.342; Ewing sarcoma vs. osteosarcoma: HR = 0.592; and chordoma vs. osteosarcoma: HR = 0.015), marital status (HR = 2.457), pulmonary metastasis (HR = 1.934), surgery at the primary site (HR = 0.164), and chemotherapy (HR = 0.084). A nomogram based on these prognostic factors could be a good predictor of cancer-specific survival.
We identified the prevalence, risk factors, and prognostic factors correlated with BM in PMBNs patients. The related nomogram could be a practical tool for therapeutic decision-making and individual counseling.
骨转移（BM）已被证明是原发性恶性骨肿瘤（PMBNs）预后不良的原因。我们旨在基于监测、流行病学和最终结果（SEER）数据库确定PMBNs伴BM患者的患病率、危险因素和预后因素。
从SEER数据库中选取2010年至2018年诊断为PMBNs的4758例患者。所有患者分为两组：BM组和非BM组。采用Pearson卡方检验和Fisher精确检验评估基线特征，并应用逻辑回归分析评估危险因素。此外，基于227例BM患者的Cox回归分析结果构建了列线图。通过一致性指数、操作特征曲线、曲线下面积、校准曲线和决策曲线分析对列线图的良好性能和临床适用性进行了检验。
227例（4.8%）患者在诊断时发生骨转移。四肢以外的原发部位（轴向：比值比，OR = 1.770；其他：OR = 1.951）、尤因肉瘤（OR = 2.845）、肿瘤较大（5-8厘米：OR = 3.403；>8厘米：OR = 5.562）、肿瘤超出骨膜（OR = 2.477）和区域淋巴结转移（OR = 2.900）与PMBNs初诊时发生BM的较高风险相关。在生存分析中发现了五个独立的预后因素：病理类型（软骨肉瘤与骨肉瘤：风险比，HR = 0.342；尤因肉瘤与骨肉瘤：HR = 0.592；脊索瘤与骨肉瘤：HR = 0.015）、婚姻状况（HR = 2.457）、肺转移（HR = 1.934）、原发部位手术（HR = 0.164）和化疗（HR = 0.084）。基于这些预后因素的列线图可以很好地预测癌症特异性生存。
我们确定了PMBNs患者中与BM相关的患病率、危险因素和预后因素。相关列线图可以成为治疗决策和个体化咨询的实用工具。
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