Li Zhenwei, Xu Bo, Cai Jingjing, Zha Zhengang
Center for Bone, Joint and Sports Medicine, The First Hospital of Jinan University, Jinan University, Guangzhou, China.
Department of Orthopedics, The Second Affiliated Hospital of Bengbu Medical College, Anhui Province, China.
J Oncol. 2023 Apr 8;2023:8635829. doi: 10.1155/2023/8635829. eCollection 2023.
The study aims to identify whether osteosarcoma patients of children and young adults will benefit from a survival profit from the choice of the operation method.
The National Cancer Institute SEER database from 2000 to 2018 was selected for a retrospective analysis of 1630 children and young adults with a primary diagnosis of osteosarcoma, 1222 who underwent limb-preserving surgery, and 408 who underwent amputation. Confounders were controlled for by propensity score matching (PSM), cancer-specific survival (CSS) was analyzed using the Kaplan-Meier method, and univariate and multivariate Cox regression was used to analyze the factors influencing the prognosis of children and young osteosarcoma patients after surgery. A nomogram plot predicted 1-, 3-, and 5- survival rate in osteosarcoma. The model's accuracy was validated by the area under the ROC and calibration curves.
After PSM, multifactor Cox regression analysis found AJCC Stage III-IV (CSS : HR = 5.26, 95% CI 1.95-14.18, =0. 001; HR = 5.54, 95% CI 2.56-12.01, < 0. 001. Limb salvage surgery (CSS : HR = 0.58, 95% CI 0.44-0.77, < 0. 001) has independent impact factors for CSS prognosis. The survival curve before and after PSM showed that patients with osteosarcoma of children and young adults who underwent limb salvage surgery had a survival benefit compared with those who underwent amputation surgery. Gender, chemotherapy, histology, primary tumor site, stage, and surgical modality were modeled in a total of six variables in the nomogram. The model exhibited good predictive performance. The AUC were 0.823, 0.74, and 0.757 for training set at 1, 3, and 5 years, respectively. The AUC of validation set 0.666, 0.722, and 0.699 at 1, 3, and 5 years, respectively. The model also predicted CSS with good fidelity for both datasets. This model was significantly superior to the 8 edition of the AJCC TNM staging system, with a better net benefit in predicting CSS in children and young adults with osteosarcoma.
Limb salvage surgery is an option for children and young adults with osteosarcoma and cancer-specific survival rates can be improved by receiving limb salvage surgery.
本研究旨在确定儿童和青年骨肉瘤患者是否会因手术方式的选择而在生存方面获益。
选取美国国立癌症研究所监测、流行病学和最终结果（SEER）数据库2000年至2018年期间1630例初诊为骨肉瘤的儿童和青年患者进行回顾性分析，其中1222例行保肢手术，408例行截肢手术。通过倾向评分匹配（PSM）控制混杂因素，采用Kaplan-Meier法分析癌症特异性生存（CSS）情况，运用单因素和多因素Cox回归分析影响儿童和青年骨肉瘤患者术后预后的因素。绘制列线图预测骨肉瘤患者1年、3年和5年生存率。通过ROC曲线下面积和校准曲线验证模型的准确性。
PSM后，多因素Cox回归分析发现美国癌症联合委员会（AJCC）III-IV期（CSS：HR = 5.26，95%CI 1.95 - 14.18，P = 0.001；HR = 5.54，95%CI 2.56 - 12.01，P < 0.001）、保肢手术（CSS：HR = 0.58，95%CI 0.44 - 0.77，P < 0.001）是CSS预后的独立影响因素。PSM前后的生存曲线显示，接受保肢手术的儿童和青年骨肉瘤患者比接受截肢手术的患者有生存获益。列线图共纳入性别、化疗、组织学类型、原发肿瘤部位、分期和手术方式6个变量。该模型表现出良好的预测性能。训练集1年、3年和5年的AUC分别为0.823、0.74和0.757。验证集1年、3年和5年的AUC分别为0.666、0.722和0.699。该模型对两个数据集的CSS预测准确性也很高。该模型显著优于AJCC TNM分期系统第8版，在预测儿童和青年骨肉瘤患者CSS方面有更好的净效益。
保肢手术是儿童和青年骨肉瘤患者的一种选择，接受保肢手术可提高癌症特异性生存率。
