Prognostic nomogram for predicting the 5-year probability of developing metastasis after neo-adjuvant chemotherapy and definitive surgery for AJCC stage II extremity osteosarcoma

Abstract

We devised a nomogram for nonmetastatic osteosarcoma that proposes improved estimates of metastasis over AJCC staging system or tumor necrosis rate. We suggest that this nomogram allows individualized risk assessments and could be used as the basis for risk-adapted therapy.

Development and external validation of nomograms predicting distant metastases and overall survival after neoadjuvant chemotherapy and surgery for patients with nonmetastatic osteosarcoma: A multi‐institutional study

“…However, few data that could be applied to a prognostic nomogram for sarcoma have been available,24 especially with respect to bone sarcoma, because of its rarity and the difficulty in collecting a sufficient number of cases 16, 19. In the current study, we developed and validated multivariate nomograms internally and externally that incorporated several commonly evaluable factors simultaneously to allow individual estimations of 3‐ and 5‐year MFS and OAS for patients with nonmetastatic osteosarcoma treated by surgery and chemotherapy with curative intent.…”

“…To date, only 2 prognostic nomograms for osteosarcoma have been available 16, 19. The first nomogram was designed to predict the 5‐year probability of metastasis after neoadjuvant chemotherapy and surgery; it was based on 365 patients with nonmetastatic osteosarcoma treated at a single center.…”

“…The first nomogram was designed to predict the 5‐year probability of metastasis after neoadjuvant chemotherapy and surgery; it was based on 365 patients with nonmetastatic osteosarcoma treated at a single center. It stratified the patients into 108 risk groups on the basis of 4 variables: age at diagnosis (3 categories), primary tumor site (3 categories), tumor size (3 categories), and histologic response to chemotherapy (4 categories) 16. The second nomogram was designed to predict the 5‐year probability of metastasis after neoadjuvant chemotherapy and limb salvage surgery; it was based on 91 patients with stage IIB osteosarcoma treated at a single center.…”

“…However, in osteosarcoma, other prognostic factors, including patient age,14, 15, 16 tumor location,5, 16 pathologic fracture,17 and responses to preoperative chemotherapy, have been reported to correlate strongly with survival 5, 16, 18. Therefore, for the prediction of survival after treatment, it would be desirable to consider these factors, and a comprehensive and easy‐to‐use tool that incorporated all of them and could be used to assess individualized survival would be valuable for decision making.…”

“…In the era of individualized cancer treatment, the use of such a tool for the estimation of survival would be particularly helpful for physicians when they are determining an appropriate interval for follow‐up or imaging. To our knowledge, however, data that could be used for developing a nomogram for osteosarcoma patients are still limited 16, 19. In addition, no externally validated nomogram has been reported to date because of the rarity of the disease and the difficulty in collecting a sufficient number of patients.…”