基于印度一家三级癌症中心大型前瞻性队列的骨肉瘤预后模型
Prognostic Modeling for Bone Sarcomas Based on a Large Prospective Cohort From a Tertiary Care Cancer Center in India.
作者信息
Bajpai Jyoti, Sarkar Laboni, Rath Sushmita, Pawar Akash, Chandrashekharan Arun, Panda Goutam, Jakar Dharmpal, Ghosh Jaya, Laskar Siddhartha, Rekhi Bharat, Khanna Nehal, Jose Jifmi, Ramdawar Mukta, Purandare Nilendu, Bhargava Prabhat, Chakrabarty Nivedita, Gala Kunal, Kembhavi Yogesh, Rangarajan Venkatesh, Banavali Shripad, Gupta Sudeep
机构信息
Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
Department of Biostatistics, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
出版信息
JCO Glob Oncol. 2025 Feb;11:e2400142. doi: 10.1200/GO.24.00142. Epub 2025 Feb 6.
PURPOSE
Outcomes of adolescents and young adults (AYA) with bone sarcomas including osteosarcoma (OGS) and Ewing sarcoma (ES) are affected by various factors including inadvertent previous treatment and poor compliance. We aimed to develop a risk-scoring system derived and validated at a tertiary care cancer center in India.
METHODS
All AYA OGS and ES cases treated at our institute with OGS-12 and Ewing's family of tumors-2001 (EFT-2001) protocols from 2011 to 2021 and 2013 to 2018, respectively, were prospectively analyzed. Weighted scores provided to each prognostic variable on the basis of approximate ratios of the beta coefficients of each factor in the multivariable model were summated to divide patients into three clinically discriminatory risk groups, validated by applying separately to derivation, validation, and whole cohorts.
RESULTS
Among 606 (81.0%) of 748 AYA with nonmetastatic OGS, significant factors included in the prognostic model were failure to complete protocol (hazard ratio [HR], 2.65), previous treatment (HR, 2.93), necrosis <90% (HR, 1.63), joint involvement (HR, 2.0), and serum alkaline phosphatase >median (204 U/L; HR, 1.63). Of 104 (39.5%) of 263 AYA with ES, significant factors were failure to complete protocol (HR, 2.84), previous treatment (HR, 6.37), necrosis <100% (HR, 8.73), and tumor size >8 cm (HR, 2.64). For 142 (38.8%) of 366 AYA with metastatic OGS, significant factors were failure to complete protocol (HR, 5.29), metastases not amenable to local treatment (HR, 1.96), necrosis <90% (HR, 1.96), and >10 metastases (HR, 2.44). For 38 (43.6%) of 82 AYA with metastatic extremity ES, significant factors were failure to complete protocol (HR, 3.88) and metastases not amenable to local treatment (HR, 10.6).
CONCLUSION
We developed simple, effective prognostic models for AYA with bone sarcomas with specific potential relevance for low- and middle-income countries.
目的
骨肉瘤（包括骨肉瘤（OGS）和尤因肉瘤（ES））的青少年和青年成人（AYA）患者的预后受多种因素影响，包括既往不经意的治疗和依从性差。我们旨在开发一种在印度一家三级癌症中心推导并验证的风险评分系统。
方法
分别对2011年至2021年以及2013年至2018年在我院按照骨肉瘤 - 12（OGS - 12）和尤因肿瘤家族 - 2001（EFT - 2001）方案治疗的所有AYA骨肉瘤和尤因肉瘤病例进行前瞻性分析。根据多变量模型中各因素的β系数的近似比值为每个预后变量赋予加权分数，将这些分数相加，从而将患者分为三个具有临床鉴别意义的风险组，并分别应用于推导队列、验证队列和整个队列进行验证。
结果
在748例非转移性骨肉瘤的AYA患者中，606例（81.0%）的预后模型中的显著因素包括未完成方案（风险比[HR]，2.65）、既往治疗（HR，2.93）、坏死<90%（HR，1.63）、关节受累（HR，2.0）以及血清碱性磷酸酶>中位数（204 U/L；HR，1.63）。在263例尤因肉瘤的AYA患者中，104例（39.5%）的显著因素为未完成方案（HR，2.84）、既往治疗（HR，6.37）、坏死<100%（HR，8.73）以及肿瘤大小>8 cm（HR，2.64）。在366例转移性骨肉瘤的AYA患者中，142例（38.8%）的显著因素为未完成方案（HR，5.29）、不可行局部治疗的转移灶（HR，1.96）、坏死<90%（HR，1.96）以及转移灶>10个（HR，2.44）。在82例转移性肢体尤因肉瘤的AYA患者中，38例（43.6%）的显著因素为未完成方案（HR，3.88）以及不可行局部治疗的转移灶（HR，10.6）。
结论
我们为骨肉瘤的AYA患者开发了简单、有效的预后模型，这些模型对低收入和中等收入国家具有特定的潜在相关性。
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