Prognostic nomograms for predicting overall and cancer-specific survival of high-grade osteosarcoma patients

Abstract

Aim: The present study aimed to develop nomograms estimating survival for patients with high-grade osteosarcoma. Methods: 1990 patients with high-grade osteosarcoma between 1994 and 2013 were retrospectively retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Data from 12 cancer registries (n = 1460) were used to conduct multivariate Cox analysis to identify independent prognostic factors. Nomograms which estimate 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) were constructed. The nomograms were internally validated for calibration and were also externally validated with an independent patient cohort from 1 cancer registry (n = 530). Results: Age, primary site, tumor size, use of surgery, and extent of disease were found to be independently associated with OS and CSS (p < 0.05). The nomograms estimating 3- and 5-year OS and CSS were developed based on these prognostic factors. The concordance indices were high in internal validation (0.726 for OS and 0.731 for CSS) and external validation (0.716 for OS and 0.724 for CSS). Internal and external calibration plots demonstrated a good agreement between nomogram prediction and actual observation. Conclusions: We constructed nomograms that accurately predict OS and CSS of high-grade osteosarcoma patients. The nomograms can be used for counseling patients and establishing risk stratification. Keywords: Osteosarcoma, Prognostic factor, Survival, Nomogram, Validation