Prognostic Nomograms for Predicting Overall Survival and Cancer-Specific Survival in Patients with Angiosarcoma, a SEER population-based study

Abstract

Backgrounds: Angiosarcoma (AS) is a kind of highly aggressive cancer with high occurrence and mortality rates. This study aimed to establish a comprehensive and validated prognostic nomogram with various clinical indicators in patients with AS.Methods: Data of patients with AS diagnosed after surgery between 2010 and 2015 was retrieved from the Surveillance Epidemiology and End Results (SEER) database. Univariate and multivariate Cox proportional hazards regression analysis were performed to identify the independent prognostic factors associated with survival to construct the predictive nomogram of 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates. Concordance-index(C-index), calibration plots and receiver operating characteristic (ROC) curves were applied to evaluate the predictive ability of the nomograms. The further decision curve analysis (DCA) was drawn to confirm the clinical usefulness of the nomograms.Results: 323 patients in total with AS were divided into the training group (N =226) and the validation group (N = 97). After the multivariate Cox regression analysis, gender, age, AJCC stage group 7th ed, T, N and M stage 7th ed, histologic grade and primary site were statistically identified as independent factors with OS and CSS (P<0.05). The C-index of the nomograms for OS and CCS in the training cohort was 0.760 (95%CI: 0.674–0.847) and 0.793 (95%CI: 0.687–0.898), meanwhile, the C-index of those in the validation cohort was 0.790 (95%CI: 0.725–0.855) and 0.888 (95%CI: 0.799–0.976) respectively. The results of calibration plots and ROC curve showed the nomograms qualified to measure the risk and prognosis. DCA exhibited good clinical utility of nomograms.Conclusion: Our study has developed novel and practical nomograms for predicting prognosis in patients with AS contributing to cancer management.