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Zou C, Huang R, Lin T, Wang Y, Tu J, Zhang L, Wang B, Huang J, Zhao Z, Xie X, Huang G, Wang K, Yin J, Shen J. Age-dependent molecular variations in osteosarcoma: implications for precision oncology across pediatric, adolescent, and adult patients. Front Oncol 2024; 14:1382276. [PMID: 38841159 PMCID: PMC11150704 DOI: 10.3389/fonc.2024.1382276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Osteosarcoma is a leading subtype of bone tumor affecting adolescents and adults. Comparative molecular characterization among different age groups, especially in pediatric, adolescents and adults, is scarce. Methods We collected samples from 194 osteosarcoma patients, encompassing pediatric, adolescent, and adult cohorts. Genomic analyses were conducted to reveal prevalent mutations and compare molecular features in pediatric, adolescent, and adult patients. Results Samples from 194 osteosarcoma patients across pediatric to adult ages were analyzed, revealing key mutations such as TP53, FLCN, NCOR1, and others. Children and adolescents showed more gene amplifications and HRD mutations, while adults had a greater Tumor Mutational Burden (TMB). Mutations in those over 15 were mainly in cell cycle and PI3K/mTOR pathways, while under 15s had more in cell cycle and angiogenesis with higher VEGFA, CCND3, TFEB mutations. CNV patterns varied with age: VEGFA and XPO5 amplifications more in under 25s, and CDKN2A/B deletions in over 25s. Genetic alterations in genes like MCL1 and MYC were associated with poor prognosis, with VEGFA mutations also indicating worse outcomes. 58% of patients had actionable mutations, suggesting opportunities for targeted therapies. Age-specific patterns were observed, with Multi-TKI mutations more common in younger patients and CDK4/6 inhibitor mutations in adults, highlighting the need for personalized treatment approaches in osteosarcoma. In a small group of patients with VEGFR amplification, postoperative treatment with multi-kinase inhibitors resulted in a PR in 3 of 13 cases, especially in patients under 15. A significant case involved a 13-year-old with a notable tumor size reduction achieving PR, even with other genetic alterations present in some patients with PD. Conclusion This study delineates the molecular differences among pediatric, adolescent, and adult osteosarcoma patients at the genomic level, emphasizing the necessity for precision diagnostics and treatment strategies, and may offer novel prognostic biomarkers for patients with osteosarcoma. These findings provide a significant scientific foundation for the development of individualized treatment approaches tailored to patients of different age groups.
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Affiliation(s)
- Changye Zou
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Renxuan Huang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tiao Lin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Jian Tu
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Bo Wang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Zhiqiang Zhao
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xianbiao Xie
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Huang
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Junqiang Yin
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingnan Shen
- Department of Musculoskeletal Oncology Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Heim TE, Hankins ML, Belayneh R, Douglas N, Dinh V, Kovvur M, Boone DN, Ukani V, Bhogal S, Patel V, Moniz TMA, Bailey KM, John I, Schoedel K, Weiss KR, Watters RJ. RNA-sequencing predicts a role of androgen receptor and aldehyde dehydrogenase 1A1 in osteosarcoma lung metastases. Oncogene 2024; 43:1007-1018. [PMID: 38361046 PMCID: PMC10978487 DOI: 10.1038/s41388-024-02957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 09/20/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
One-third of pediatric patients with osteosarcoma (OS) develop lung metastases (LM), which is the primary predictor of mortality. While current treatments of patients with localized bone disease have been successful in producing 5-year survival rates of 65-70%, patients with LM experience poor survival rates of only 19-30%. Unacceptably, this situation that has remained unchanged for 30 years. Thus, there is an urgent need to elucidate the mechanisms of metastatic spread in OS and to identify targetable molecular pathways that enable more effective treatments for patients with LM. We aimed to identify OS-specific gene alterations using RNA-sequencing of extremity and LM human tissues. Samples of extremity and LM tumors, including 4 matched sets, were obtained from patients with OS. Our data demonstrate aberrant regulation of the androgen receptor (AR) pathway in LM and predicts aldehyde dehydrogenase 1A1 (ALDH1A1) as a downstream target. Identification of AR pathway upregulation in human LM tissue samples may provide a target for novel therapeutics for patients with LM resistant to conventional chemotherapy.
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Affiliation(s)
- Tanya E Heim
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA.
| | - Margaret L Hankins
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Rebekah Belayneh
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Nerone Douglas
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Vu Dinh
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Murali Kovvur
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - David N Boone
- University of Pittsburgh Department of Biomedical Informatics, Pittsburgh, PA, USA
| | - Vrutika Ukani
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Sumail Bhogal
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Vaidehi Patel
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Taylor M A Moniz
- Columbia University with Trinity College, Dublin, UK
- UPMC Hillman Cancer Center Academy, Pittsburgh, PA, USA
| | - Kelly M Bailey
- University of Pittsburgh School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
| | - Ivy John
- University of Pittsburgh Department of Pathology, Pittsburgh, PA, USA
| | - Karen Schoedel
- University of Pittsburgh Department of Pathology, Pittsburgh, PA, USA
| | - Kurt R Weiss
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
| | - Rebecca J Watters
- University of Pittsburgh Department of Orthopaedic Surgery, Pittsburgh, PA, USA
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Li Z, Yang X, Xing S. Identifying the Best Candidate for Primary Tumor Resection in Patients With Advanced Osteosarcoma. Cancer Control 2024; 31:10732748241242244. [PMID: 38532697 DOI: 10.1177/10732748241242244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Not all patients with stage III and IV osteosarcoma who undergo surgery to remove the primary tumor will benefit from surgery; therefore, we developed a nomogram model to test the hypothesis that only a subset of patients will benefit from surgery. METHODS 412 patients were screened from the Surveillance, Epidemiology and End Results (SEER) database. Subsequently, 1:1 propensity score matching (PSM) was used to screen and balance confounders. We first made the hypothesis that patients who underwent the procedure would benefit more. A multivariate Cox model was used to explore the independent influencing factors of CSS in two groups (benefit group and non-benefit group) and constructed nomograms with predicted prognosis. Finally, receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were used to verify the performance of the nomogram. RESULTS Of these patients, approximately 110 did not undergo primary tumour resection. After passing PSM, they were divided into a surgical group and a non-surgical group. Age, primary site and chemotherapy as calculated independent factors were used to construct a nomogra. The predicted nomogram showed good consistency in terms of the ROC curve and the calibration curve, and the DCA curve showed a certain clinical utility. Finally, dividing the surgical patients into surgical beneficiaries and surgical non-beneficiaries, a Kaplan-Meier analysis showed that the nomogram can identify patients with osteosarcoma who can benefit from surgery. CONCLUSION A practical predictive model was established to determine whether patients with stage III or IV osteosarcoma would benefit from surgery.
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Affiliation(s)
- Zhengjiang Li
- Department of Orthopedics, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Xingyao Yang
- Department of Orthopedics, The Fifth People's Hospital of Chengdu, Chengdu, China
| | - Shuxing Xing
- Department of Orthopedics, The Fifth People's Hospital of Chengdu, Chengdu, China
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Deng G, Chen P. Characteristics and prognostic factors of adult patients with osteosarcoma from the SEER database. Medicine (Baltimore) 2023; 102:e33653. [PMID: 37713904 PMCID: PMC10508457 DOI: 10.1097/md.0000000000033653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/10/2023] [Indexed: 09/17/2023] Open
Abstract
Osteosarcoma is the most common bone malignancy. There are many studies on the prognostic factors of children and adolescents, but the characteristics and prognostic factors of adult osteosarcoma are rarely studied. The aim of this study was to construct a nomogram for predicting the prognosis of adult osteosarcoma. Information on all osteosarcoma patients aged ≥ 18 years from 2004 to 2015 was downloaded from the surveillance, epidemiology and end results database. A total of 70% of the patients were included in the training set and 30% of the patients were included in the validation set. Univariate log-rank analysis and multivariate cox regression analysis were used to screen independent risk factors affecting the prognosis of adult osteosarcoma. These risk factors were used to construct a nomogram to predict 3-year and 5-year prognosis in adult osteosarcoma. Multivariate cox regression analysis yielded 6 clinicopathological features (age, primary site, tumor size, grade, American Joint Committee on Cancer stage, and surgery) for the prognosis of adult osteosarcoma patients in the training cohort. A nomogram was constructed based on these predictors to assess the prognosis of adult patients with osteosarcoma. Concordance index, receiver operating characteristic and calibration curves analyses also showed satisfactory performance of the nomogram in predicting prognosis. The constructed nomogram is a helpful tool for exactly predicting the prognosis of adult patients with osteosarcoma, which could enable patients to be more accurately managed in clinical practice.
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Affiliation(s)
- Guanghua Deng
- Ya’an Hospital of Traditional Chinese Medicine, Department of Orthopedics, Ya’an, China
| | - Pingbo Chen
- The Fourth Affiliated Hospital of Xinjiang Medical University, Department of Orthopedics, Urumqi, China
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Fu Y, Yu Y, Zhou Y, Li T, Xie Y, Wang Y, Ran Q, Chen Y, Fan X. The fibrinogen-albumin ratio as a novel prognostic factor for elderly patients with osteosarcoma. Medicine (Baltimore) 2023; 102:e34926. [PMID: 37682137 PMCID: PMC10489207 DOI: 10.1097/md.0000000000034926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/03/2023] [Indexed: 09/09/2023] Open
Abstract
To analyze the prognostic value of fibrinogen-albumin ratio (FAR) in predicting the overall survival in elderly osteosarcoma patients. One hundred nineteen elderly osteosarcoma patients (> 40 years old) from 2 centers were retrospectively reviewed and analyzed. The cutoff values of the biomarker were calculated via receiver operating characteristic curves, and the cohort was divided into high FAR group and low FAR group. The association between the FAR and clinical-pathological parameters was analyzed. And the prognosis of elderly osteosarcoma patients and the potential risk factors were analyzed using Kaplan-Meier method and Cox proportional hazards model. Finally, a clinical nomogram was constructed, and its predictive capacity was verified. According to receiver operating characteristic results, the cutoff value for FAR was 0.098, and the enrolled patients were divided into the low FAR group and high FAR group. The FAR was significantly correlated with several clinical-pathological characteristics, including age, tumor size, tumor stage, recurrence, and metastasis. Moreover, the multivariate Cox analyses results showed that the FAR, pathological fracture, and metastasis were independent risk factors for overall survival in elderly osteosarcoma patients. The predictive nomogram was subsequently constructed, representing satisfactory predictive performance for prognosis in elderly patients with osteosarcoma. The FAR value is a promising indicator for elderly osteosarcoma patients, which is correlated with the various clinical characteristics and prognosis. A clinical nomogram integrating FAR and other clinical indicators is a convenient and available tool to assess the prognosis and manage the individualized and precise treatment of elderly patients with osteosarcoma.
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Affiliation(s)
- Yang Fu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yang Yu
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yi Zhou
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Tong Li
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yizhou Xie
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yehui Wang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Qiang Ran
- Department of Orthopaedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Yiming Chen
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Xiaohong Fan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
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Tong Y, Jiang L, Cui Y, Pi Y, Gong Y, Zhao D. Clinical characteristic-assisted surgical benefit stratification for resection of primary tumor in patients with advanced primary malignant bone neoplasms: a population-based propensity score-matched analysis. Front Oncol 2023; 13:960502. [PMID: 37746283 PMCID: PMC10512233 DOI: 10.3389/fonc.2023.960502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background Primary tumor resection (PTR) is the standard treatment for patients with primary malignant bone neoplasms (PMBNs). However, it remains unclear whether patients with advanced PMBNs still benefit from PTR. This study aimed to develop a prediction model to estimate the beneficial probability of PTR for this population. Methods This study extracted data from patients diagnosed with advanced PMBNs, as recorded in the Surveillance, Epidemiology, and End Results (SEER) database, with the period from 2004 to 2015. The patient cohort was then bifurcated into two groups: those who underwent surgical procedures and the non-surgery group. Propensity score matching (PSM) was utilized to mitigate any confounding factors in the study. The survival rates of patients from both the surgical and non-surgery groups were evaluated using Kaplan-Meier (K-M) curves analysis. Moreover, the study used this method to assess the capacity of the nomogram to distinguish patients likely to derive benefits from surgical intervention. The study was grounded in the hypothesis that patients who underwent PTR and survived beyond the median overall survival (OS) time would potentially benefit from the surgery. Subsequently, logistic regression analysis was performed to ascertain significant predictors, facilitating the development of a nomogram. This nomogram was subjected to both internal and external validation using receiver operating characteristic curves, area under the curve analysis, calibration plots, and decision curve analysis. Results The SEER database provided a total of 839 eligible patients for the study, among which 536 (63.9%) underwent PTR. Following a 2:1 PSM analysis, patients were classified into two groups: 364 patients in the surgery group and 182 patients in the non-surgery group. Both K-M curves and multivariate Cox regression analysis revealed that patients who received PTR had a longer survival duration, observed both before and after PSM. Crucial factors such as age, M stage, and tumor size were identified to be significantly correlated with surgical benefits in patients with advanced PMBNs. Subsequently, a nomogram was developed that uses these independent predictors. The validation of this predictive model confirmed its high accuracy and excellent discrimination ability of the nomogram to distinguish patients who would most likely benefit from surgical intervention. Conclusion In this study, we devised a user-friendly nomogram to forecast the likehood of surgical benefits for patients diagnosed with advanced PMBNs. This tool facilitates the identification of the most suitable candidates for PTR, thus promoting more discerning and effective use of surgical intervention in this patient population.
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Affiliation(s)
- Yuexin Tong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Liming Jiang
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yuekai Cui
- The Second Clinical Medical School of The Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yangwei Pi
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Yan Gong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
| | - Dongxu Zhao
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
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Pechlivanidou E, Antonopoulos I, Margariti RE. Gender equality challenges in orthopaedic surgery: a systematic review. INTERNATIONAL ORTHOPAEDICS 2023; 47:2143-2171. [PMID: 37433883 DOI: 10.1007/s00264-023-05876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Several studies have examined gender-equality challenges and ways to improve women's representation and management. Orthopaedic surgeons and patients are less gender equitable than them of other surgical disciplines. This systematic review summarizes these findings and highlights orthopaedic surgery gender inequality. METHODS Search of the PubMed, Embase, and Cochrane databases was carried out to extract human studies investigating the gender gap in orthopaedics, trying to highlight the equality challenges orthopaedic surgery faces. Studies incorporating patients with comorbidities in which gender is a proven risk factor, and pregnant women were excluded. RESULTS This systematic review included 59 studies involving 692,435 people (mean females/males ratio: 4.44), spanning the years 1987-2023. Regarding the targeted population, 35 (59.32%) studies focused on patients, while 24 (40.68%) on physicians. Orthopaedic surgery is described as an unfriendly career field for women as surgeons or sports leading physicians while women are generally under represented in the academic field of orthopaedics. Regarding patients, female gender consists both a risk and prognostic factor influencing the prevalence of degenerative disease and the outcome of the operative treatment in reconstructive orthopaedics. Female gender is a risk factor for multiple sports injuries and influences the pathogenetic mechanisms resulting in ACL reconstruction. Regarding spine surgery, women are less likely to have surgery suggested, and such suggestion underlines severe disease's progression. CONCLUSIONS Gender differences affect orthopaedic patient-physician-healthcare system interactions. Recognizing biases and their patterns is useful to improve the actual situation. By preventing those an unbiased, tolerant, and egalitarian workplace for physicians and a healthcare system that provides the best treatment to patients could be created.
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Affiliation(s)
- Evmorfia Pechlivanidou
- 1st Department of Orthopaedics, P. & A. Kyriakou Children's Hospital, Athens, Greece.
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Ioannis Antonopoulos
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rodanthi E Margariti
- 1st Department of Orthopaedics, P. & A. Kyriakou Children's Hospital, Athens, Greece
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Bielack SS, Lindner LH, Egerer G, Benzler K, Blattmann C, Grube M, Hahn D, Kager L, Kühne T, Mettmann V, Reichardt P, Hecker-Nolting S. Osteosarcomas in older adults: A report from the Cooperative Osteosarcoma Study Group. J Geriatr Oncol 2023; 14:101445. [PMID: 36842425 DOI: 10.1016/j.jgo.2023.101445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/16/2022] [Accepted: 01/30/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION Osteosarcoma is typically a disease of the young, but may affect any age. Little is known about the disease in older patients beyond retirement age. We aim to describe the characteristics, treatment, and outcomes of older adult patients registered with our cooperative group. MATERIALS AND METHODS The database of the Cooperative Osteosarcoma Study Group (COSS) was searched for osteosarcoma patients diagnosed from 1980 to 2020 who were aged 65 years or older at diagnosis. Affected individuals were analyzed for presenting factors, treatments employed, and outcomes. RESULTS Fifty-five eligible patients were detected (median age 68 [range: 65-84] years; male:female = 25:30). Among these patients, 15/55 (27%) tumors were secondary malignancies, 41/55 (75%) were high-grade central, 4/55 (7%) surface, and 10/55 (18%) extraosseous malignancies, and all but three high-grade. Primary metastases were present in 15/55 (27%) patients. Surgery was reported for 46/55 (84%) patients, radiotherapy for 6/54 (11%, 1 unknown), chemotherapy for 42/50 (84%, 5 unknown). A complete surgical remission was achieved in 31/55 (56%). There were two toxic deaths. With a median follow-up of 1.7 (range: 0.1-18.0) years for all 55 patients and 2.2 (0.1-12.4) years for 24 survivors, event-free and overall survival at 2/5 years were 39.6% (standard error: 6.8%) / 24.5% (6.5%) and 62.0% (7.1%) / 32.7% (7.5%), respectively. Tumor site, metastatic status, surgery, and a complete surgical remission were prognostic for event-free and/or overall survival. DISCUSSION Osteosarcomas can occur in older individuals. It is more often secondary, axially located, or extraosseous than in younger patients. However, the same treatment principles seem to apply, and selected patients may be cured. Multi-center cooperation is encouraged, thereby gathering expertise for such a rare disease presentation.
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Affiliation(s)
- Stefan S Bielack
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany; Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Universitätsklinikum Münster, Münster, Germany.
| | | | - Gerlinde Egerer
- Universitätsklinikum Heidelberg, Innere Medizin V: Hämatologie, Onkologie und Rheumatologie, Heidelberg, Germany
| | - Katrin Benzler
- Universitätsklinikum Tübingen; Innere Medizin II, Zentrum für Weichteilsarkome/GIST und Knochentumore, Tübingen, Germany
| | - Claudia Blattmann
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Matthias Grube
- Universitätsklinikum Regensburg, Klinik und Poliklinik für Innere Medizin III, Regensburg, Germany
| | - Dennis Hahn
- Klinik für Hämatologie, Onkologie, Stammzelltransplantation und Palliativmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Katharinenhospital, Stuttgart, Germany
| | - Leo Kager
- St. Anna Kinderspital, Universitätsklinik für Kinder- und Jugendheilkunde der Medizinischen Universität Wien, and St. Anna Children's Cancer Research Institute (CCRI), Vienna, Austria
| | - Thomas Kühne
- Universitäts-Kinderspital beider Basel, Abteilung für Pädiatrische Onkologie / Hämatologie, Basel, Switzerland
| | - Vanessa Mettmann
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Peter Reichardt
- Onkologie und Palliativmedizin, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Stefanie Hecker-Nolting
- Cooperative Osteosarkom-Studiengruppe Gruppe COSS, Pädiatrie 5 (Onkologie, Hämatologie, Immunologie), Zentrum für Kinder-, Jugend- und Frauenmedizin, Stuttgart Cancer Center, Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
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Gong T, Huang Q, Tang F, Wang Y, Li Z, Luo Y, Min L, Zhou Y, Tu C. Activity and safety of apatinib monotherapy or apatinib combined with chemotherapy for patients with metastatic or unresectable osteosarcoma over the age of 40 years: A retrospective analysis. Front Oncol 2022; 12:1031787. [PMID: 36387068 PMCID: PMC9664205 DOI: 10.3389/fonc.2022.1031787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Osteosarcoma commonly develops during childhood and adolescence. Only one-third of osteosarcoma patients have been clinically detected over the age of 40 years, and the survivorship of those patients is quite dismal. Apatinib, a novel multitarget angiogenesis inhibitor, has shown a short-term efficacy in advanced or metastatic osteosarcoma. However, the data for apatinib in the older patients with osteosarcoma are limited. We aim to evaluate the efficacy and safety of apatinib combined with chemotherapy versus apatinib monotherapy in the treatment of patients over 40 years old with metastatic or unresectable osteosarcoma. METHODS We retrospectively analyzed the patients with metastatic osteosarcoma who were treated with apatinib monotherapy or apatinib combined with chemotherapy between May 2015 and December 2018 in the Department of Orthopedics at West China Hospital. Apatinib was initially administered with a dose of 500 mg daily, and the dose was adjusted according to toxicity. The objective response rate (ORR), disease control rate (DCR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS) were investigated. The treatment-related adverse events and the safety of apatinib were also documented. RESULTS A total of 45 patients (28 men, 17 women) with metastatic or unresectable osteosarcoma were finally included, and 41 patients received at least one cycle of treatment and were evaluable for efficacy. Of 41 patients, 24 who were intolerant to intensive chemotherapy or have failed standard chemotherapy received apatinib monotherapy, and 17 patients were treated with apatinib plus chemotherapy. The median PFS and median OS were longer in the group treated with apatinib combined with chemotherapy than those of the apatinib monotherapy group (5.6 months vs. 2.6 months; 15.1 months vs. 9.7 months). Moreover, the median DOR was significantly prolonged in the group treated with apatinib combined with chemotherapy compared with that in the monotherapy group. CONCLUSION Apatinib demonstrated promising activity in patients over 40 years old with metastatic or unresectable osteosarcoma. The combination of apatinib and chemotherapy conferred a durable response compared with apatinib monotherapy, which might be an alternative therapeutic strategy for the management of osteosarcoma in older patients.
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Affiliation(s)
- Taojun Gong
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Huang
- Operating Room, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Fan Tang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yitian Wang
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Luo
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Wang J, Wu Z, Zheng M, Yu S, Zhang X, Xu X. CD146 is closely associated with the prognosis and molecular features of osteosarcoma: Guidance for personalized clinical treatment. Front Genet 2022; 13:1025306. [PMID: 36338992 PMCID: PMC9635853 DOI: 10.3389/fgene.2022.1025306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Osteosarcoma (OSA), a focus for orthopedic surgeons, always results in severe death due to metastasis. CD146 is severely expressed in several tumors, indicating its potential as a biomarker for OSA. Method: Two OSA cohorts were enrolled in this study. A Therapeutically Applicable Research to Generate Effective Treatments-Osteosarcoma (TARGET-OS) cohort was used as a training cohort, and GSE21257 was used as the external validation cohort. The R package “limma” was used to discriminate the differentially expressed genes among CD146-high and CD146-low patients and was further annotated by the enriched signaling pathways. The R package MOVICS was used to evaluate immune infiltration and the response to chemotherapy and immunotherapy. All statistical analyses were performed by R version 4.0.2, and p < 0.05 was considered statistically significant. Result: CD146 plays an important role in promoting the progression, invasion, and metastasis of several tumors. In the current study, we first revealed an integrative unfavorable prognosis in patients with tumors (p < 0.01, HR: 1.10, 95% CI: 1.07-1.14). CD146 is tightly correlated with m5C RNA methylation modification genes in OSA. Furthermore, we revealed that CD146 acts as an oncogene in OSA patients and is linked to poor prognosis in both the TARGET-OS cohort (p = 0.019, HR: 2.61, 95% CI: 1.171-5.834) and the GSE21257 cohort (p = 0.005, HR: 3.61, 95% CI: 1.474-8.855), with a total of 137 patients, regardless of whether they were adjusted for clinical pathological features. Highly-expressed CD146 impacts the signaling pathways of cytokine‒cytokine receptor interactions and is associated with the high infiltration of immunocytes. Moreover, patients with high CD146 expression were more likely to be sensitive to anti-PD-1 immunotherapy, while patients with low expression of CD146 were more likely to be sensitive to cisplatin and doxorubicin chemotherapy. Conclusion: Overall, CD146 is an independent prognostic factor for OSA patients and can help doctors select clinical treatment strategies.
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Wen Y, Zhang H, Zhi K, Li M. Influence of marital status on the treatment and survival of middle-aged and elderly patients with primary bone cancer. Front Med (Lausanne) 2022; 9:1001522. [DOI: 10.3389/fmed.2022.1001522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe role of spousal support has been recognized to benefit patients with many chronic diseases and cancers. However, the impact of marital status on the survival of middle-aged and elderly patients with primary bone tumors remains elusive.Materials and methodsThe data of patients aged ≥ 45 years with primary bone tumors diagnosed between 2000 and 2018 were extracted from the Surveillance, Epidemiology, and End Results Database. Kaplan–Meier analysis was used to assess the overall survival and tumor-specific survival of patients. The Cox proportional hazards and Fine-and-Gray models were used to calculate the hazard ratios (HRs) and sub-distribution HRs (sHR) and the corresponding 95% confidence interval (CI) of all-cause mortality and tumor-specific mortality, respectively.ResultsA total of 5,640 primary bone tumors were included in the study. In 45–59 years cohort, married, unmarried, divorced and widowed accounted for 66.0, 21.0, 11.2, and 1.8%, respectively; while 64.3, 10.1, 8.8, and 16.8% in 60+ years cohort, respectively. The widowed patients had a lower proportion of early-stage tumors at diagnosis than that married, unmarried, and divorced patients (31.0% vs. 36% vs. 37.1% vs. 39.4%; P = 0.008), and had a higher proportion of patients who did not undergo surgery than that of married, unmarried, and divorced patients (38.6% vs. 21.3% vs. 24.6% vs. 24.4%; P < 0.001). The widowed population had an increased risk of all-cause mortality (HR, 1.68; 95% CI, 1.50–1.88; P < 0.001) and disease-related mortality (HR, 1.33; 95% CI, 1.09–1.61; P = 0.005) compared with the married population.ConclusionThe marital status of middle-aged and elderly people can affect the tumor stage at diagnosis, treatment, and survival prognosis of patients with primary bone cancer. Widowed patients are more inclined to choose non-surgical treatment and have the worst prognosis.
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Gao B, Wang MD, Li Y, Huang F. Risk stratification system and web-based nomogram constructed for predicting the overall survival of primary osteosarcoma patients after surgical resection. Front Public Health 2022; 10:949500. [PMID: 35991065 PMCID: PMC9389295 DOI: 10.3389/fpubh.2022.949500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Previous prediction models of osteosarcoma have not focused on survival in patients undergoing surgery, nor have they distinguished and compared prognostic differences among amputation, radical and local resection. This study aimed to establish and validate the first reliable prognostic nomogram to accurately predict overall survival (OS) after surgical resection in patients with osteosarcoma. On this basis, we constructed a risk stratification system and a web-based nomogram. Methods We enrolled all patients with primary osteosarcoma who underwent surgery between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. In patients with primary osteosarcoma after surgical resection, univariate and multivariate cox proportional hazards regression analyses were utilized to identify independent prognostic factors and construct a novel nomogram for the 1-, 3-, and 5-year OS. Then the nomogram's predictive performance and clinical utility were evaluated by the concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Result This study recruited 1,396 patients in all, with 837 serving as the training set (60%) and 559 as the validation set (40%). After COX regression analysis, we identified seven independent prognostic factors to develop the nomogram, including age, primary site, histological type, disease stage, AJCC stage, tumor size, and surgical method. The C-index indicated that this nomogram is considerably more accurate than the AJCC stage in predicting OS [Training set (HR: 0.741, 95% CI: 0.726–0.755) vs. (HR: 0.632, 95% CI: 0.619–0.645); Validation set (HR: 0.735, 95% CI: 0.718–0.753) vs. (HR: 0.635, 95% CI: 0.619–0.652)]. Moreover, the area under ROC curves, the calibration curves, and DCA demonstrated that this nomogram was significantly superior to the AJCC stage, with better predictive performance and more net clinical benefits. Conclusion This study highlighted that radical surgery was the first choice for patients with primary osteosarcoma since it provided the best survival prognosis. We have established and validated a novel nomogram that could objectively predict the overall survival of patients with primary osteosarcoma after surgical resection. Furthermore, a risk stratification system and a web-based nomogram could be applied in clinical practice to assist in therapeutic decision-making.
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Affiliation(s)
- Bing Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Meng-die Wang
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yanan Li
- Department of Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Fei Huang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Fei Huang
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Tang C, Wang D, Wu Y, Xu H, Zhang H. Surgery Has Positive Effects on Spinal Osteosarcoma Prognosis: A Population-Based Database Study. World Neurosurg 2022; 164:e367-e386. [PMID: 35504478 DOI: 10.1016/j.wneu.2022.04.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The treatment of osteosarcoma of the spine remains controversial. Our aim was to explore the treatment of patients with spinal osteosarcoma. METHODS We analyzed the data from 727 spinal osteosarcoma patients from the Surveillance, Epidemiology, and End Results database from 1973 to 2015. X-tile software was used to find the optimal cutoff values for age and economic income. The Kaplan-Meier estimator method was used to analyze overall survival and cancer-specific survival. Univariate and multivariate Cox analyses were used to identify the independent prognostic factors. Propensity score matching was used to reduce the possibility of selection bias. A logistic regression model was used to clarify the relevant factors affecting a patient's decision to undergo surgery. RESULTS Among 727 eligible spinal osteosarcoma patients, 370 (50.9%) had undergone surgery and 357 (49.1%) had not undergone surgery. Significant differences were found in the effects of patient age at diagnosis, Surveillance, Epidemiology, and End Results historical stage, and tumor grade on the patients' decision to undergo surgery (P < 0.05). Surgery was an independent prognostic factor for overall survival and cancer-specific survival of patients with spinal osteosarcoma. The same results were found after 1:1 propensity score matching. The surgery group had more favorable survival compared with the nonsurgery group. CONCLUSIONS Surgery can provide survival benefits for patients with osteosarcoma of the spine. The patients with spinal osteosarcoma who had undergone surgery experienced favorable survival benefits. Thus, surgery can be a suitable treatment for patients with spinal osteosarcoma.
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Affiliation(s)
- Chao Tang
- Orthopedic Department, People's Hospital of Putuo District, Tongji University School of Medicine, Shanghai, China; Pain Department, Pizhou City People's Hospital, Xuzhou Medical University, Xuzhou City, China
| | - Dongdong Wang
- Orthopedics Department, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuman Wu
- Fifth Clinical Medical College, Hubei University of Medicine, Hubei, China
| | - Hengyuan Xu
- Jiakou Community Health Service Center, Pizhou City People's Hospital, Xuzhou Medical University, Xuzhou City, China
| | - Hailong Zhang
- Orthopedic Department, People's Hospital of Putuo District, Tongji University School of Medicine, Shanghai, China.
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Cole S, Gianferante DM, Zhu B, Mirabello L. Osteosarcoma: a Surveillance, Epidemiology, and End Results program-based analysis from 1975 to 2017. Cancer 2022; 128:2107-2118. [PMID: 35226758 DOI: 10.1002/cncr.34163] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/29/2022] [Accepted: 02/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Osteosarcoma is the most common primary bone malignancy. As a rare cancer, population-based studies remain small with limited information on finer demographic categories. Recent studies have reported important genetic differences based on age and ethnicity, and more detailed studies are needed to better understand potentially important osteosarcoma risk groups. METHODS Incidence and survival rates for 5016 patients with osteosarcoma from the Surveillance, Epidemiology, and End Results (SEER) program (1975-2017) were analyzed by age (0-9, 10-24, 25-59, and >60 years old), race/ethnicity, histologic subtype, stage, and tumor location using SEER*Stat software. RESULTS For cases 0 to 9 years old, incidence of primary osteosarcoma was similar between the sexes, increased significantly throughout the study period (P < .05), and the 5-year relative survival has steadily increased over time. Blacks had the highest incidence in all aged cases combined and a significant increase in incidence throughout the study period (P < .05). Overall, survival rates for all cases have remained relatively unchanged over recent decades, with worse survival observed in males, American Indian/Alaska Native cases, older patients, metastatic disease, axial tumors, and subsequent osteosarcoma cases. For cases 0 to 24 years old, the incidence of subsequent osteosarcoma increased 3-fold since the 2000s. CONCLUSION Important differences in osteosarcoma incidence and survival, particularly for the youngest children, ethnic minorities, and subsequent osteosarcoma, are identified. A genetic risk factor may be associated with observed ancestry-specific incidence differences and illustrates the importance of analyzing osteosarcoma by specific age groups and ethnicities to better understand their unique epidemiology and underlying biology. LAY SUMMARY Osteosarcoma is the most common bone cancer, but still a relatively rare disease, and previous studies have had limited information on finer demographics. Using a large database, osteosarcoma incidence and survival patterns are thoroughly evaluated and important differences, especially for the youngest children, ethnic minorities, and subsequent osteosarcoma cases, are identified.
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Affiliation(s)
- Sarah Cole
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland.,Walter Reed National Military Medical Center, Bethesda, Maryland
| | - D Matthew Gianferante
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Bin Zhu
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Lisa Mirabello
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Peng C, Hao Y, Ren Z, Zhu G, Yu L. Prognostic factors of chondroblastic osteosarcoma and nomogram development for prediction: A population-based, STROBE-compliant study. Medicine (Baltimore) 2021; 100:e26021. [PMID: 34114989 PMCID: PMC8202533 DOI: 10.1097/md.0000000000026021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/29/2021] [Indexed: 01/04/2023] Open
Abstract
The present study aimed to develop nomograms to predict survival in patients with chondroblastic osteosarcoma (COS).An analysis was conducted of 320 cases of COS collected from the surveillance, epidemiology, and end results (SEER) database between 2004 and 2015. Independent prognostic factors were screened using univariate and multivariate Cox analyses. Subsequently, nomograms were established to predict the patients' cancer-specific survival (CSS) and overall survival (OS) rates. The prediction accuracy and discriminative ability of the nomograms were examined using calibration curves and the concordance index (C-index).As revealed in the univariate and multivariate Cox regression analysis, age, tumor size, the primary site, the presence of metastasis, a history of having undergone surgery, and a history of having received radiotherapy were found to be independent prognostic factors associated with survival in patients with COS (all P < .05). Furthermore, age >39 years, the presence of distant metastasis, no history of having undergone any surgery, and tumor size >103 mm were found to be associated with poor prognosis in patients, while the primary site of the mandible and no history of having undergone radiotherapy showed associations with a more favorable prognosis in patients. Next, nomograms were constructed to predict the OS and CSS in patients with COS.We constructed nomograms that can provide accurate survival predictions in patients with chondroblastic osteosarcoma. These nomograms can help surgeons customize the treatment strategies for patients with chondroblastic osteosarcoma.
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Cao M, Zhang J, Xu H, Lin Z, Chang H, Wang Y, Huang X, Chen X, Wang H, Song Y. Identification and Development of a Novel 4-Gene Immune-Related Signature to Predict Osteosarcoma Prognosis. Front Mol Biosci 2020; 7:608368. [PMID: 33425993 PMCID: PMC7785859 DOI: 10.3389/fmolb.2020.608368] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 11/24/2020] [Indexed: 12/22/2022] Open
Abstract
Osteosarcoma (OS) is a malignant disease that develops rapidly and is associated with poor prognosis. Immunotherapy may provide new insights into clinical treatment strategies for OS. The purpose of this study was to identify immune-related genes that could predict OS prognosis. The gene expression profiles and clinical data of 84 OS patients were obtained from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET) database. According to non-negative matrix factorization, two molecular subtypes of immune-related genes, C1 and C2, were acquired, and 597 differentially expressed genes between C1 and C2 were identified. Univariate Cox analysis was performed to get 14 genes associated with survival, and 4 genes (GJA5, APBB1IP, NPC2, and FKBP11) obtained through least absolute shrinkage and selection operator (LASSO)-Cox regression were used to construct a 4-gene signature as a prognostic risk model. The results showed that high FKBP11 expression was correlated with high risk (a risk factor), and that high GJA5, APBB1IP, or NPC2 expression was associated with low risk (protective factors). The testing cohort and entire TARGET cohort were used for internal verification, and the independent GSE21257 cohort was used for external validation. The study suggested that the model we constructed was reliable and performed well in predicting OS risk. The functional enrichment of the signature was studied through gene set enrichment analysis, and it was found that the risk score was related to the immune pathway. In summary, our comprehensive study found that the 4-gene signature could be used to predict OS prognosis, and new biomarkers of great significance for understanding the therapeutic targets of OS were identified.
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Affiliation(s)
- Mingde Cao
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Junhui Zhang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hualiang Xu
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhujian Lin
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hong Chang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yuchen Wang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xusheng Huang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiang Chen
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Hua Wang
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yancheng Song
- Department of Orthopedics, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
- *Correspondence: Yancheng Song
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Jiang Y, Wang T, Wei Z. Construction and Validation of Nomograms for Predicting the Prognosis of Juvenile Osteosarcoma: A Real-World Analysis in the SEER Database. Technol Cancer Res Treat 2020; 19:1533033820947718. [PMID: 33054584 PMCID: PMC7570778 DOI: 10.1177/1533033820947718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/21/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Osteosarcoma is one of the most common malignant bone tumors, with a high incidence in adolescence. The objective of this study was to construct prognostic nomograms for predicting the prognosis of juvenile osteosarcoma. METHODS Patients with osteosarcoma diagnosed between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. The essential clinical predictors were identified with univariate and multivariate Cox analysis. Nomograms were constructed to predict the 3- and 5-year cancer- specific survival (CSS) and overall survival (OS). Concordance index (C-index) and calibration plots were performed to validate the predictive performance of nomograms. RESULTS We enrolled 736 adolescents with osteosarcoma from the SEER database, with 516 samples grouped into a training cohort and 220 samples grouped into a validation cohort. In multivariate analysis of the training cohort, predictors including tumor size, surgery treatment and AJCC stage were found to be associated with OS and CSS, while age was only associated with CSS. Construction of nomograms based on these predictors was performed to evaluate the prognosis of adolescents with osteosarcoma. The C-index and calibration curves also showed the satisfactory performance of these nomograms for prognosis prediction. CONCLUSION The developed nomograms are useful tools for precisely predicting the prognosis of adolescents with osteosarcoma, which could enable patients to be more accurately managed in clinical practice.
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Affiliation(s)
- Yao Jiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tianyu Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zizheng Wei
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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