Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China.
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Front Public Health. 2022 Aug 22;10:955427. doi: 10.3389/fpubh.2022.955427. eCollection 2022.
The prognosis of patients with primary osseous spinal neoplasms (POSNs) presented with distant metastases (DMs) is still poor. This study aimed to evaluate the independent risk and prognostic factors in this population and then develop two web-based models to predict the probability of DM in patients with POSNs and the overall survival (OS) rate of patients with DM.
The data of patients with POSNs diagnosed between 2004 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistics regression analyses were used to study the risk factors of DM. Based on independent DM-related variables, we developed a diagnostic nomogram to estimate the risk of DM in patients with POSNs. Among all patients with POSNs, those who had synchronous DM were included in the prognostic cohort for investigating the prognostic factors by using Cox regression analysis, and then a nomogram incorporating predictors was developed to predict the OS of patients with POSNs with DM. Kaplan-Meier (K-M) survival analysis was conducted to study the survival difference. In addition, validation of these nomograms were performed by using receiver operating characteristic (ROC) curves, the area under curves (AUCs), calibration curves, and decision curve analysis (DCA).
A total of 1345 patients with POSNs were included in the study, of which 238 cases (17.70%) had synchronous DM at the initial diagnosis. K-M survival analysis and multivariate Cox regression analysis showed that patients with DM had poorer prognosis. Grade, T stage, N stage, and histological type were found to be significantly associated with DM in patients with POSNs. Age, surgery, and histological type were identified as independent prognostic factors of patients with POSNs with DM. Subsequently, two nomograms and their online versions (https://yxyx.shinyapps.io/RiskofDMin/ and https://yxyx.shinyapps.io/SurvivalPOSNs/) were developed. The results of ROC curves, calibration curves, DCA, and K-M survival analysis together showed the excellent predictive accuracy and clinical utility of these newly proposed nomograms.
We developed two well-validated nomograms to accurately quantify the probability of DM in patients with POSNs and predict the OS rate in patients with DM, which were expected to be useful tools to facilitate individualized clinical management of these patients.
原发性骨脊柱肿瘤（POSNs）伴远处转移（DM）患者的预后仍较差。本研究旨在评估该人群的独立风险和预后因素，然后开发两个基于网络的模型来预测 POSNs 患者发生 DM 的概率和 DM 患者的总生存率（OS）。
从监测、流行病学和最终结果（SEER）数据库中提取 2004 年至 2017 年间诊断为 POSNs 的患者数据。采用单因素和多因素逻辑回归分析研究 DM 的危险因素。基于独立的 DM 相关变量，我们开发了一个诊断列线图来估计 POSNs 患者发生 DM 的风险。在所有 POSNs 患者中，纳入同时患有 DM 的患者作为预后队列，通过 Cox 回归分析研究预后因素，然后开发一个纳入预测因素的列线图来预测患有 DM 的 POSNs 患者的 OS。采用 Kaplan-Meier（K-M）生存分析研究生存差异。此外，通过受试者工作特征（ROC）曲线、曲线下面积（AUC）、校准曲线和决策曲线分析（DCA）对这些列线图进行验证。
共纳入 1345 例 POSNs 患者，其中 238 例（17.70%）在初始诊断时同时患有 DM。K-M 生存分析和多因素 Cox 回归分析显示，患有 DM 的患者预后较差。等级、T 分期、N 分期和组织学类型被发现与 POSNs 患者的 DM 显著相关。年龄、手术和组织学类型被确定为患有 DM 的 POSNs 患者的独立预后因素。随后，开发了两个列线图及其在线版本（https://yxyx.shinyapps.io/RiskofDMin/ 和 https://yxyx.shinyapps.io/SurvivalPOSNs/）。ROC 曲线、校准曲线、DCA 和 K-M 生存分析的结果共同表明，这些新提出的列线图具有良好的预测准确性和临床实用性。
我们开发了两个经过良好验证的列线图，可以准确量化 POSNs 患者发生 DM 的概率，并预测 DM 患者的 OS 率，有望成为帮助这些患者进行个体化临床管理的有用工具。
