De Sanctis Rita, Zelic Renata, Santoro Armando
Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
Front Oncol. 2022 Sep 20;12:941896. doi: 10.3389/fonc.2022.941896. eCollection 2022.
Prognostic models for patients with soft tissue sarcoma (STS) of the extremities have been developed from large multi-institutional datasets with mixed results. We aimed to develop predictive nomograms for sarcoma-specific survival (SSS) and, for the first time, long-term local recurrence (LR) and distant recurrence (DR) in patients with STS of the extremities treated at our institution.
Data from patients treated at Humanitas Cancer Center from 1997 to 2015 were analyzed. Variable selection was based on the clinical knowledge and multivariable regression splines algorithm. Perioperative treatments were always included in the model. Prognostic models were developed using Cox proportional hazards model, and model estimates were plotted in nomograms predicting SSS at 5 and 10 years and LR and DR at 2, 5, and 10 years. Model performance was estimated internally bootstrapping, in terms of optimism-corrected discrimination (Harrell C-index) and calibration (calibration plots).
Data on 517 patients were analyzed. At 5 and 10 years, SSS was 68.1% [95% confidence interval (CI), 63.8-72.1] and 55.6% (50.5-60.3), respectively. LR was 79.1% (95% CI, 75.3-82.4), 71.1% (95% CI, 66.7-75.1), and 66.0% (95% CI, 60.7-70.7) at 2, 5, and 10 years, respectively, whereas DR was 65.9% (95% CI, 61.6-69.9), 57.5% (95% CI, 53.0-61.8), and 52.1% (95% CI, 47.1-56.8) at 2, 5, and 10 years, respectively. SSS nomogram included age, gender, margins, tumor size, grading, and histotype. LR and DR nomograms incorporated mostly the same variables, except for age for DR; LR nomogram did not include gender but included anatomic site. The optimism-corrected C-indexes were 0.73 and 0.72 for SSS at 5 and 10 years, respectively; 0.65, 0.64, and 0.64 for LR at 2, 5, and 10 years, respectively; and 0.68 for DR at 2, 5, and 10 years. Predicted probabilities were close to the observed ones for all outcomes.
We developed and validated three nomograms for STS of the extremities predicting the probability of SSS at 5 and 10 years and LR and DR at 2, 5, and 10 years. By accounting for the perioperative treatment, these models allow prediction for future patients who had no perioperative treatment, thus being useful in the clinical decision-making process.
基于大型多机构数据集已开发出肢体软组织肉瘤（STS）患者的预后模型，但结果不一。我们旨在为在我院接受治疗的肢体STS患者开发肉瘤特异性生存（SSS）预测列线图，并首次开发长期局部复发（LR）和远处复发（DR）预测列线图。
分析了1997年至2015年在胡梅塔斯癌症中心接受治疗的患者数据。变量选择基于临床知识和多变量回归样条算法。围手术期治疗始终纳入模型。使用Cox比例风险模型开发预后模型，并将模型估计值绘制在列线图中，以预测5年和10年的SSS以及2年、5年和10年的LR和DR。通过内部自举法，根据乐观校正鉴别力（Harrell C指数）和校准（校准图）评估模型性能。
分析了517例患者的数据。5年和10年时，SSS分别为68.1%[95%置信区间（CI），63.8 - 72.1]和55.6%（50.5 - 60.3）。2年、5年和10年时，LR分别为79.1%（95%CI，75.3 - 82.4）、71.1%（95%CI，66.7 - 75.1）和66.0%（95%CI，60.7 - 70.7），而DR在2年、5年和10年时分别为65.9%（95%CI，61.6 - 69.9）、57.5%（95%CI，53.0 - 61.8）和52.1%（95%CI，47.1 - 56.8）。SSS列线图包括年龄、性别、切缘、肿瘤大小、分级和组织学类型。LR和DR列线图纳入的变量大多相同，DR列线图除外年龄；LR列线图不包括性别，但包括解剖部位。5年和10年时SSS的乐观校正C指数分别为0.73和0.72；2年、5年和10年时LR的乐观校正C指数分别为0.65、0.64和0.64；2年、5年和10年时DR的乐观校正C指数为0.68。所有结局的预测概率均与观察到的概率接近。
我们开发并验证了三个用于肢体STS的列线图，可预测5年和10年的SSS概率以及2年、5年和10年的LR和DR概率。通过考虑围手术期治疗，这些模型可对未接受围手术期治疗的未来患者进行预测，从而有助于临床决策过程。
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