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Annals of Oncology Advance Access originally published online on January 19, 2009
Annals of Oncology 2009 20(5):955-960; doi:10.1093/annonc/mdn723
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

sarcomas and melanoma

Prognostic nomogram for predicting the 5-year probability of developing metastasis after neo-adjuvant chemotherapy and definitive surgery for AJCC stage II extremity osteosarcoma

M. S. Kim1, S.-Y. Lee2, T. R. Lee3, W. H. Cho2, W. S. Song2, J.-S. Koh1, J. A. Lee4, J. Y. Yoo5 and D.-G Jeon2,*

1 Department of Pathology
2 Department of Orthopedic Surgery, Korea Cancer Center Hospital, Seoul
3 Department of Information Statistics, Korea National Open University, Seoul
4 Department of Pediatrics
5 Department of Radiology, Korea Cancer Center Hospital, Seoul, Korea

* Correspondence to: Dr D.-G. Jeon, Department of Orthopedic Surgery, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. Tel: +82-2-970-1242; Fax: +82-2-970-2403; E-mail: dgjeon{at}kcch.re.kr

Background: In this retrospective study, we developed and internally validate a nomogram for predicting 5-year metastasis probability for nonmetastatic extremity osteosarcoma.

Patients and methods: We reviewed 365 osteosarcoma patients treated at our institute from 1990 to 2003. Clinicopathologic variables were recorded. Multivariate analysis using Cox proportional hazards regression was done and this Cox model was used as the basis for the nomogram.

Results: By American Joint Committee on Cancer (AJCC) staging system, 141 patients (38.6%) were stage IIA and 224 (61.4%) were stage IIB. Multivariate Cox model identified patient age at diagnosis, tumor size, humeral location, and tumor necrosis rate after chemotherapy as correlated with metastasis-free survival. The degree of contribution of each covariate to the total point was tumor location, tumor necrosis rate, maximal tumor diameter, and age in decreasing order. The concordance index for the model was 0.78. Nomogram discrimination was superior to that of AJCC stage (concordance index 0.78 versus 0.68; P = 0.02) and histologic response grouping (concordance index 0.78 versus 0.69; P = 0.0004).

Conclusions: We devised a nomogram for nonmetastatic osteosarcoma that proposes improved estimates of metastasis over AJCC staging system or tumor necrosis rate. We suggest that this nomogram allows individualized risk assessments and could be used as the basis for risk-adapted therapy.

Key words: nomogram, osteosarcoma, prognosis

Received for publication June 8, 2008. Accepted for publication October 28, 2008.


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