Diagnostic And Prognostic Models For Children And Adolescent Osteosarcoma Patients With Lung Metastasis

Objective: To establish two nomogram prediction models to quantitatively analyze the risk factors for the diagnosis and prognosis of lung metastasis in young patients with osteosarcoma,and to evaluate their predictive performance.Methods: In this retrospective study,618 young osteosarcoma patients from the years 2010 to 2015 were included from the Surveillance,Epidemiology,and End Results(SEER)database.The patients were divided into two groups randomly,a training set of 434 patients and a validation set of 184 patients,with a ratio of 7:3.Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for lung metastasis and to build the nomogram.Risk factors for the overall survival(OS)of patients with lung metastasis were analyzed using Cox regression analysis.A second nomogram was also constructed to predict the survival rates.The nomograms were then evaluated using calibration curves,receiver operating characteristic(ROC)curves,and decision curve analysis(DCA).Results:1.There were 114(18.45%)patients diagnosed with lung metastasis at initial diagnosis.Multivariate logistic regression analysis suggested that T stage,N stage,and bone metastasis were statistically associated with lung metastasis(P<0.001).2.The ROC analysis revealed that area under the curve(AUC)values were0.751 and 0.821 in the training set and validation set,respectively,indicating good predictive discrimination.3.Multivariate Cox proportional hazard regression analysis indicated that age,surgery,chemotherapy,primary site,and bone metastasis were statistically associated with prognosis in osteosarcoma patients with lung metastasis(P <0.05).4.The time-dependent ROC curves showed that the AUC for predicting 1-year,2-year,and 3-year survival were 0.817,0.792,and 0.815 in the training set and0.772,0.807,and 0.804 in the internal validation set,respectively.Conclusion : 1.T stage,N stage,and bone metastasis were independent risk factors for lung metastasis in newly diagnosed young osteosarcoma patients.Age,surgery,chemotherapy,primary site,and bone metastasis were independent prognostic factors for young osteosarcoma patients with lung metastasis.2.Two nomogram prediction models were established and validated to predict lung metastasis and to guide the prognosis of young osteosarcoma patients with lung metastasis.These predictive models can help clinicians to further enhance the accuracy of treatment decisions.