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

Koichi Ogura, Tomohiro Fujiwara, Hideo Yasunaga, Hiroki Matsui, Dae Geun Jeon, Wan Hyeong Cho, Hiroaki Hiraga, Takeshi Ishii, Tsukasa Yonemoto, Hiroto Kamoda, Toshihumi Ozaki, Eiji Kozawa, Yoshihiro Nishida, Hideo Morioka, Toru Hiruma, Shigeki Kakunaga, Takafumi Ueda, Yusuke Tsuda, Hirotaka Kawano, Akira Kawai

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND In this era of individualized cancer treatment, data that could be applied to predicting the survival of patients with osteosarcoma are still limited because of the rarity of the disease and the difficulty in accumulating a sufficient number of patients. Therefore, a multi-institutional collaboration was implemented to develop and externally validate nomograms that would predict metastasis-free survival (MFS) and overall survival (OAS) for patients with nonmetastatic osteosarcoma. METHODS This study retrospectively examined 1070 patients treated with neoadjuvant chemotherapy and surgery for nonmetastatic osteosarcoma. Data from Japanese patients (n = 557) were used to develop multivariate nomograms based on Cox regression. Six clinical and pathologic variables were built into nomograms estimating the probability of MFS and OAS 3 and 5 years after diagnosis. The model was internally validated for discrimination and calibration with bootstrap resampling and was externally validated with an independent patient cohort from Korea (n = 513). RESULTS A patient's age, tumor site, and histologic response were found to have a stronger influence on MFS and OAS in the model than sex, tumor size, or pathologic fracture. The nomograms and calibration plots based on these results well predicted the probability of MFS (concordance index, 0.631) and OAS (concordance index, 0.679). The concordance indices for external validation were 0.682 for MFS and 0.665 for OAS. CONCLUSIONS The nomograms were externally validated and verified to be useful for the prediction of MFS and OAS and for the assessment of the postoperative prognosis. They can be used for counseling patients and for establishing appropriate surveillance strategies after surgery. Cancer 2015;121:3844-3852.

Original languageEnglish
Pages (from-to)3844-3852
Number of pages9
JournalCancer
Volume121
Issue number21
DOIs
Publication statusPublished - Nov 1 2015

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Nomograms
Osteosarcoma
Neoplasm Metastasis
Drug Therapy
Survival
Calibration
Neoplasms
Spontaneous Fractures
Korea
Counseling

Keywords

  • external validation
  • nomogram
  • osteosarcoma
  • prognosis
  • survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

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. / Ogura, Koichi; Fujiwara, Tomohiro; Yasunaga, Hideo; Matsui, Hiroki; Jeon, Dae Geun; Cho, Wan Hyeong; Hiraga, Hiroaki; Ishii, Takeshi; Yonemoto, Tsukasa; Kamoda, Hiroto; Ozaki, Toshihumi; Kozawa, Eiji; Nishida, Yoshihiro; Morioka, Hideo; Hiruma, Toru; Kakunaga, Shigeki; Ueda, Takafumi; Tsuda, Yusuke; Kawano, Hirotaka; Kawai, Akira.

In: Cancer, Vol. 121, No. 21, 01.11.2015, p. 3844-3852.

Research output: Contribution to journalArticle

Ogura, K, Fujiwara, T, Yasunaga, H, Matsui, H, Jeon, DG, Cho, WH, Hiraga, H, Ishii, T, Yonemoto, T, Kamoda, H, Ozaki, T, Kozawa, E, Nishida, Y, Morioka, H, Hiruma, T, Kakunaga, S, Ueda, T, Tsuda, Y, Kawano, H & Kawai, A 2015, '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', Cancer, vol. 121, no. 21, pp. 3844-3852. https://doi.org/10.1002/cncr.29575
Ogura, Koichi ; Fujiwara, Tomohiro ; Yasunaga, Hideo ; Matsui, Hiroki ; Jeon, Dae Geun ; Cho, Wan Hyeong ; Hiraga, Hiroaki ; Ishii, Takeshi ; Yonemoto, Tsukasa ; Kamoda, Hiroto ; Ozaki, Toshihumi ; Kozawa, Eiji ; Nishida, Yoshihiro ; Morioka, Hideo ; Hiruma, Toru ; Kakunaga, Shigeki ; Ueda, Takafumi ; Tsuda, Yusuke ; Kawano, Hirotaka ; Kawai, Akira. / 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. In: Cancer. 2015 ; Vol. 121, No. 21. pp. 3844-3852.
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T1 - Development and external validation of nomograms predicting distant metastases and overall survival after neoadjuvant chemotherapy and surgery for patients with nonmetastatic osteosarcoma

T2 - A multi-institutional study

AU - Ogura, Koichi

AU - Fujiwara, Tomohiro

AU - Yasunaga, Hideo

AU - Matsui, Hiroki

AU - Jeon, Dae Geun

AU - Cho, Wan Hyeong

AU - Hiraga, Hiroaki

AU - Ishii, Takeshi

AU - Yonemoto, Tsukasa

AU - Kamoda, Hiroto

AU - Ozaki, Toshihumi

AU - Kozawa, Eiji

AU - Nishida, Yoshihiro

AU - Morioka, Hideo

AU - Hiruma, Toru

AU - Kakunaga, Shigeki

AU - Ueda, Takafumi

AU - Tsuda, Yusuke

AU - Kawano, Hirotaka

AU - Kawai, Akira

PY - 2015/11/1

Y1 - 2015/11/1

N2 - BACKGROUND In this era of individualized cancer treatment, data that could be applied to predicting the survival of patients with osteosarcoma are still limited because of the rarity of the disease and the difficulty in accumulating a sufficient number of patients. Therefore, a multi-institutional collaboration was implemented to develop and externally validate nomograms that would predict metastasis-free survival (MFS) and overall survival (OAS) for patients with nonmetastatic osteosarcoma. METHODS This study retrospectively examined 1070 patients treated with neoadjuvant chemotherapy and surgery for nonmetastatic osteosarcoma. Data from Japanese patients (n = 557) were used to develop multivariate nomograms based on Cox regression. Six clinical and pathologic variables were built into nomograms estimating the probability of MFS and OAS 3 and 5 years after diagnosis. The model was internally validated for discrimination and calibration with bootstrap resampling and was externally validated with an independent patient cohort from Korea (n = 513). RESULTS A patient's age, tumor site, and histologic response were found to have a stronger influence on MFS and OAS in the model than sex, tumor size, or pathologic fracture. The nomograms and calibration plots based on these results well predicted the probability of MFS (concordance index, 0.631) and OAS (concordance index, 0.679). The concordance indices for external validation were 0.682 for MFS and 0.665 for OAS. CONCLUSIONS The nomograms were externally validated and verified to be useful for the prediction of MFS and OAS and for the assessment of the postoperative prognosis. They can be used for counseling patients and for establishing appropriate surveillance strategies after surgery. Cancer 2015;121:3844-3852.

AB - BACKGROUND In this era of individualized cancer treatment, data that could be applied to predicting the survival of patients with osteosarcoma are still limited because of the rarity of the disease and the difficulty in accumulating a sufficient number of patients. Therefore, a multi-institutional collaboration was implemented to develop and externally validate nomograms that would predict metastasis-free survival (MFS) and overall survival (OAS) for patients with nonmetastatic osteosarcoma. METHODS This study retrospectively examined 1070 patients treated with neoadjuvant chemotherapy and surgery for nonmetastatic osteosarcoma. Data from Japanese patients (n = 557) were used to develop multivariate nomograms based on Cox regression. Six clinical and pathologic variables were built into nomograms estimating the probability of MFS and OAS 3 and 5 years after diagnosis. The model was internally validated for discrimination and calibration with bootstrap resampling and was externally validated with an independent patient cohort from Korea (n = 513). RESULTS A patient's age, tumor site, and histologic response were found to have a stronger influence on MFS and OAS in the model than sex, tumor size, or pathologic fracture. The nomograms and calibration plots based on these results well predicted the probability of MFS (concordance index, 0.631) and OAS (concordance index, 0.679). The concordance indices for external validation were 0.682 for MFS and 0.665 for OAS. CONCLUSIONS The nomograms were externally validated and verified to be useful for the prediction of MFS and OAS and for the assessment of the postoperative prognosis. They can be used for counseling patients and for establishing appropriate surveillance strategies after surgery. Cancer 2015;121:3844-3852.

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