Prognostic Value of Various Nutritional Assessment Indicators on Long Term and Short Term Outcomes for Patients with High Grade Osteosarcoma Receiving Surgical Resection

Abstract

Background: Many researchers have focused on exploring the association between patients’ nutritional status and clinical outcomes with some easy-to-reach indicators, especially in some carcinoma with high incidence. However, there was little attention on sarcomas and the objective of this study was to evaluate the prognostic value of some innovative nutrition associated indexes on patients with high grade osteosarcoma receiving surgical excision. Method: We retrospectively included patients’ clinical characteristics diagnosed as high grade osteosarcomas histologically receiving surgical excision from January 2008 to June 2018. Body mass index (BMI), Glasgow prognostic score (GPS), systematic inflammatory index (SII), and controlling nutritional (CONUT) score were calculated as nutritional associated factors to evaluate their prognostic value. The primary outcome was overall survival (OS) while the secondary outcome was the postoperative length of hospitalization. The relationship between clinical features and outcomes were performed by Cox and logistic regression analysis, respectively. The independent prognostic factors were chosen to construct predicted model whose internal and external accuracy were validated by concordance index (C-index), Brier score, and calibration plots.Results: High score of GPS predicted worse OS [HR (95% CI): 3.122 (1.982-4.918) versus 2.208 (1.014-4.804)] and higher rank of CONUT predicted poorer prognosis [HR (95% CI): 2.573 (1.616-4.097)] independently. The CONUT score was selected as the only prognostic factor on the length of hospitalization [HR (95% CI): 2.137 (1.270-3.596)]. The nomogram plots were used to visualize the results of predicted models whose performance was evaluated from the aspects of calibration and discrimination. Conclusion: Our study suggested prognostic value of nutritional assessment indexes including GPS and CONUT score that appropriate preoperative intervention which could optimize patients’ nutrition associated indicators may improve prognosis on patients with high grade osteosarcoma receiving surgical excision.Level of evidence: Level Ⅲ, prognostic study