Development and Validation of Nomograms Predicting Overall and Cancer-specific Survival of Spinal and Pelvic Tumor Patients with Distant Metastasis

Abstract Background: Primary spinal bone tumors with distant metastasis are a sign of advanced stage and are usually accompanied by poor prognosis. This study is to identify the risk factors and establish prognostic nomograms to predict 1- and 3-year overall survival (OS) and cancer-specific survival (CSS) rates for spinal and pelvic bone tumor patients with distant metastasis.Patients and methods: Spinal and pelvic bone tumor patients with distant metastasis between 1998 and 2016 were selected for this study from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms to predict 1- and 3-year OS and CCS rates were constructed based on independent risk factors identified by univariate and multivariate Cox analyses. Concordance indexes (C-indexes), receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to assess the nomograms.Results: All patients (n=343) were randomly divided into a training cohort (n=243) and validation cohort (n=100). No significant differences were found in thedemographic data of all patients in the training and validation cohorts. Ultimately, only four independent risk factors (patient age, histology, grade and surgery) were identified as significantly associated with OS and CCS. The C-indices were 0.722 (95% CI, 0.685 to 0.759) and 0.686 (95% CI, 0.61 to 0.760) for the internal validation and external validation of the OS nomogram, respectively. Similarly, the C-indices based on the CCS nomogram were 0.717 (95% CI, 0.678 to 0.757) and 0.695 (95% CI, 0.619 to 0.771) for the internal validation and external validation, respectively. The calibration curves revealed that the predicted survival and actual survival were in concordance. DCA showed the clinical utility and benefits of the nomograms.Conclusion: The nomograms we constructed based on the SEER database can accurately predict individual patient survival.

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Development and Validation of a Simple-to-Use Nomogram to Predict Early Death in Metastatic Pancreatic Adenocarcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.729175 ◽

2021 ◽

Vol 11 ◽

Author(s):

Zhong Zhang ◽

Juan Pu ◽

Haijun Zhang

Keyword(s):

Risk Factors ◽

Pancreatic Adenocarcinoma ◽

Validation Cohort ◽

External Validation ◽

Significant Risk ◽

Early Death ◽

Seer Database ◽

Data Set ◽

Internal Validation ◽

Chinese Cohort

BackgroundPancreatic adenocarcinoma (PCa) is a highly aggressive malignancy with high risk of early death (survival time ≤3 months). The present study aimed to identify associated risk factors and develop a simple-to-use nomogram to predict early death in metastatic PCa patients.MethodsPatients diagnosed with metastatic PCa between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were collected for model construction and internal validation. An independent data set was obtained from China for external validation. Independent risk variables contributed to early death were identified by logistic regression models, which were then used to construct a nomogram. Internal and external validation was performed to evaluate the nomogram using calibration curves and the receiver operating characteristic curves.ResultsA total of 19,464 patients in the SEER cohort and 67 patients in the Chinese cohort were included. Patients from the SEER database were randomly divided into the training cohort (n = 13,040) and internal validation cohort (n = 6,424). Patients in the Chinese cohort were selected for the external validation cohort. Overall, 10,484 patients experienced early death in the SEER cohort and 35 in the Chinese cohort. A reliable nomogram was constructed on the basis of 11 significant risk factors. Internal validation and external validation of the nomogram showed high accuracy in predicting early death. Decision curve analysis demonstrated that this predictive nomogram had excellent and potential clinical applicability.ConclusionThe nomogram provided a simple-to-use tool to distinguish early death in patients with metastatic PCa, assisting clinicians in implementing individualized treatment regimens.

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Clinicopathological Characteristics and Prognosis in Endometrial Cancer With Bone Metastasis: A SEER-Based Study of 584 Women

Frontiers in Oncology ◽

10.3389/fonc.2021.694718 ◽

2021 ◽

Vol 11 ◽

Author(s):

Hejia Hu ◽

Zhan Wang ◽

Miaofeng Zhang ◽

Feng Niu ◽

Qunfei Yu ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Bone Metastasis ◽

Brain Metastases ◽

Systemic Chemotherapy ◽

Tumor Grade ◽

Seer Database ◽

Tumor Subtype ◽

Local Surgery ◽

Independent Risk Factors

PurposeBone metastasis from endometrial cancer (EC) is rare and poorly described. The purpose of the present study was to investigate the correlation between the clinically accessible factors and survival time among EC patients with bone metastasis.Patients and MethodsWe retrospectively identified and reviewed EC patients with bone metastasis from 2010 to 2016, based on the Surveillance, Epidemiology and End Results (SEER) database. Univariable and multivariable Cox regressions were applied to evaluate the effects of clinical variables on survival. Kaplan–Meier plots were used to visually demonstrate the correlation between independent risk factors and survival.ResultsClinical data of 584 EC patients with bone metastasis from the SEER database were analyzed. EC patients with bone metastasis experienced extremely poor survival, with 1-year overall survival (OS) and cancer-specific survival (CSS) rates 33.8 and 35.8%, respectively. Variables associated with OS and CSS in the univariable analysis included race, tumor grade, tumor subtype, tumor size, lung, liver and brain metastases, surgery, radiotherapy, and chemotherapy. In the multivariable analysis, tumor grade, tumor subtype, liver and brain metastases, local surgery, and systemic chemotherapy remained independent risk factors for OS and CSS. However, local radiotherapy was an independent predictor of OS, not CSS.ConclusionsWe identified several factors affect the survival of EC patients with bone metastasis, which is useful for clinicians to assess patients’ outcomes. Our study supports surgery and radiotherapy of primary EC, and systemic chemotherapy for prolonging survival among EC patients with bone metastasis, which lays a solid foundation for defining optimal treatment strategy in this specific cohort.

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Multi-Institutional Validation of a New Renal Cancer–Specific Survival Nomogram

Journal of Clinical Oncology ◽

10.1200/jco.2006.06.1218 ◽

2007 ◽

Vol 25 (11) ◽

pp. 1316-1322 ◽

Cited By ~ 330

Author(s):

Pierre I. Karakiewicz ◽

Alberto Briganti ◽

Felix K.-H. Chun ◽

Quoc-Dien Trinh ◽

Paul Perrotte ◽

...

Keyword(s):

Renal Cancer ◽

Proportional Hazards ◽

Predictive Accuracy ◽

External Validation ◽

Cox Proportional Hazards ◽

Cancer Specific Survival ◽

Internal Validation ◽

Fuhrman Grade ◽

Histologic Subtype ◽

Cancer Specific Mortality

Purpose We tested the hypothesis that the prediction of renal cancer–specific survival can be improved if traditional predictor variables are used within a prognostic nomogram. Patients and Methods Two cohorts of patients treated with either radical or partial nephrectomy for renal cortical tumors were used: one (n = 2,530) for nomogram development and for internal validation (200 bootstrap resamples), and a second (n = 1,422) for external validation. Cox proportional hazards regression analyses modeled the 2002 TNM stages, tumor size, Fuhrman grade, histologic subtype, local symptoms, age, and sex. The accuracy of the nomogram was compared with an established staging scheme. Results Cancer-specific mortality was observed in 598 (23.6%) patients, whereas 200 (7.9%) died as a result of other causes. Follow-up ranged from 0.1 to 286 months (median, 38.8 months). External validation of the nomogram at 1, 2, 5, and 10 years after nephrectomy revealed predictive accuracy of 87.8%, 89.2%, 86.7%, and 88.8%, respectively. Conversely, the alternative staging scheme predicting at 2 and 5 years was less accurate, as evidenced by 86.1% (P = .006) and 83.9% (P = .02) estimates. Conclusion The new nomogram is more contemporary, provides predictions that reach further in time and, compared with its alternative, which predicts at 2 and 5 years, generates 3.1% and 2.8% more accurate predictions, respectively.

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Development and validation of nomograms for prediction of overall survival and cancer-specific survival of patients of colorectal cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz182 ◽

2019 ◽

Vol 50 (3) ◽

pp. 261-269

Author(s):

Jieyun Zhang ◽

Yue Yang ◽

Xiaojian Fu ◽

Weijian Guo

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Prognostic Model ◽

Cox Regression ◽

External Validation ◽

Cancer Prognosis ◽

Cancer Specific Survival ◽

Internal Validation ◽

Development And Validation

Abstract Purpose Nomograms are intuitive tools for individualized cancer prognosis. We sought to develop a clinical nomogram for prediction of overall survival and cancer-specific survival for patients with colorectal cancer. Methods Patients with colorectal cancer diagnosed between 1988 and 2006 and those who underwent surgery were retrieved from the Surveillance, Epidemiology, and End Results database and randomly divided into the training (n = 119 797) and validation (n = 119 797) cohorts. Log-rank and multivariate Cox regression analyses were used in our analysis. To find out death from other cancer causes and non-cancer causes, a competing-risks model was used, based on which we integrated these significant prognostic factors into nomograms and subjected the nomograms to bootstrap internal validation and to external validation. Results The 1-, 3-, 5- and 10-year probabilities of overall survival in patients of colorectal cancer after surgery intervention were 83.04, 65.54, 54.79 and 38.62%, respectively. The 1-, 3-, 5- and 10-year cancer-specific survival was 87.36, 73.44, 66.22 and 59.11%, respectively. Nine independent prognostic factors for overall survival and nine independent prognostic factors for cancer specific survival were included to build the nomograms. Internal and external validation CI indexes of overall survival were 0.722 and 0.721, and those of cancer-specific survival were 0.765 and 0.766, which was satisfactory. Conclusions Nomograms for prediction of overall survival and cancer-specific survival of patients with colorectal cancer. Performance of the model was excellent. This practical prognostic model may help clinicians in decision-making and design of clinical studies.

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Preoperative parameters to predict incidental (T1a and T1b) prostate cancer

Canadian Urological Association Journal ◽

10.5489/cuaj.1890 ◽

2014 ◽

Vol 8 (11-12) ◽

pp. 815 ◽

Cited By ~ 4

Author(s):

Hirofumi Sakamoto ◽

Kazuhiro Matsumoto ◽

Nozomi Hayakawa ◽

Takahiro Maeda ◽

Atsuko Sato ◽

...

Keyword(s):

Prostate Cancer ◽

Risk Factors ◽

Needle Biopsy ◽

Prostate Volume ◽

External Validation ◽

Specific Antigen ◽

Patient Age ◽

Incidental Prostate Cancer ◽

Patient Âgé ◽

Independent Risk Factors

Introduction: Prostate cancer has been found incidentally in transurethral resection of the prostate (TURP) specimens without prior diagnosis in 5% to 13% of the patients. We evaluated whether incidental prostate cancer (stages T1a and T1b) could be predicted preoperatively.Methods: TURP was performed in 307 patients between 2006 and 2011. Patient age, prostate-specific antigen (PSA) level, total prostate volume, transitional zone volume, PSA density, history of needle biopsy, and pathological diagnosis on TURP specimen were assessed. We analyzed the association between these parameters and prostate cancer detection.Results: Incidental prostate cancer was found in 31 patients (10.1%), and 13 cases (4.2%) had cancer with T1b and/or Gleason ≥7. Multivariate analysis demonstrated that age ≥75 years (odds ratio [OR] 2.58, p = 0.022), prostate volume ≤50 cc (OR 4.11, p < 0.001), and the absence of preoperative needle biopsy despite PSA ≥4 ng/mL (OR 2.65, p = 0.046) were independent risk factors. In patients who had 2 or 3 of these risk factors, incidental prostate cancer and cancer with T1b and/or Gleason ≥7 were observed in 25% to 50% and 16% to 25% cases, respectively.Conclusions: Older patient age, small prostate volume, and the absence of previous needle biopsy (despite a high PSA level) might be independent risk factors for detecting incidental prostate cancer, although external validation is warranted to confirm our results.

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Establishment of a nomogram model to predict macrosomia in pregnant women with gestational diabetes mellitus

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04049-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yujiao Zou ◽

Yan Zhang ◽

Zhenhua Yin ◽

Lili Wei ◽

Bohan Lv ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Logistic Regression ◽

Gestational Diabetes ◽

Confidence Interval ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

External Validation ◽

Amniotic Fluid Index ◽

Independent Risk Factors

Abstract Aim To establish a nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus in China. Methods We retrospectively collected the medical records of 783 pregnant women with gestational diabetes who underwent prenatal examinations and delivered at the Affiliated Hospital of Qingdao University from October 2019 to October 2020. The pregnant women were randomly divided into two groups in a 4:1 ratio to generate and validate the model. The independent risk factors for macrosomia in pregnant women with gestational diabetes mellitus were analyzed by multivariate logistic regression, and the nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus was established and verified by R software. Results Logistic regression analysis showed that prepregnancy body mass index, weight gain during pregnancy, fasting plasma glucose, triglycerides, biparietal diameter and amniotic fluid index were independent risk factors for macrosomia (P < 0.05). The areas under the ROC curve for internal and external validation of the model were 0.813 (95 % confidence interval 0.754–0.862) and 0.903 (95 % confidence interval 0.588–0.967), respectively. The calibration curve was a straight line with a slope close to 1. Conclusions In this study, we constructed a nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus. The model has good discrimination and calibration abilities, which can help clinical healthcare staff accurately predict macrosomia in pregnant women with gestational diabetes mellitus.

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Characteristics and Prognostic Factors of Patients with Chondrosarcoma Older Than 60 Years ： An Analysis of 610 Cases from the SEER Database

10.21203/rs.3.rs-689163/v2 ◽

2021 ◽

Author(s):

Tailong Chen ◽

Nan Zhou ◽

Zhongxin Tang ◽

Xing Guo ◽

Wengang Wang

Keyword(s):

Prognostic Factors ◽

Distant Metastasis ◽

Seer Database ◽

Dedifferentiated Chondrosarcoma ◽

Rare Type ◽

Histologic Subtype ◽

Race And Gender ◽

Kaplan Meier ◽

Independent Risk Factors ◽

And Gender

Abstract Background: Chondrosarcoma is a rare type of bone tumor which more commonly found in adults range from 40 to 60 years old. Few studies has described the characteristic and prognostic factors of patients older than 60 years. This study aimed to study this feature and identify the prognostic factors based on SEER database.Methods: Thus, we collected clinicopathological data of chondrosarcoma patients in the Surveillance, Epidemiology, and End Results registry database from 1975 to 2018, and then use the Kaplan-Meier to analyze the patients’ survival. We also utilize Cox proportional hazard model to explore the prognostic factors and relevant characteristic including patients’ baseline demographics (age, race, and gender), tumor characteristics (tumor extension, histologic subtype, therapy, primary site, stage and grade.Results: After the implementation of exclusion criteria, there were 610 patients with chondrosarcoma older than 60 years. Our data showed that the incidence of chondrosarcoma is slightly higher in men than in women (52.3% vs 47.7%). In general, 90.8% of tumor had metastasized to distant sites. Meanwhile, 41.8% of tumors occurred in axial location (pelvis, spine, and ribs), 50.8% of tumors occurred in extremity (long or short bones of the upper or lower extremity), and 7.4% in other location (mandible, skull, and other atypical locations). Dedifferentiated chondrosarcoma (hazard ratio [HR] =2.553; 95% confidence interval [CI]= 1.754-3.716), grade (g2:HR:=1.299; 95% CI:=0.888-1.900, g3:HR=1.839;95% CI= 1.174-2.881, g4:HR=3.284,95%CI=2.053-5.253), distant metastasis (HR=3.264; 95% CI= (2.288-4.058), non-surgery perform (HR = 2.854; 95% CI= 2.022-4.028) were independent risk factors for 5-year overall survival.Conclusion: In conclusion, higher grade, non-surgery perform, dedifferentiated chondrosarcoma and distant metastasis indicated worse prognosis survival. Surgery can significantly improve the survival time of patients.

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Correlation of the AKT/mTOR signaling pathway with the clinicopathological features and prognosis of nasopharyngeal carcinoma

European Journal of Histochemistry ◽

10.4081/ejh.2021.3304 ◽

2021 ◽

Vol 65 (4) ◽

Author(s):

Yan Wang ◽

Jie Sun ◽

Ninghua Yao

Keyword(s):

Risk Factors ◽

Nasopharyngeal Carcinoma ◽

Signaling Pathway ◽

Distant Metastasis ◽

Clinicopathological Features ◽

Mtor Signaling ◽

Mtor Signaling Pathway ◽

Positive Expression ◽

Mucosal Tissues ◽

Independent Risk Factors

The primary aim of this study was to examine the correlation of the AKT/mTOR signaling pathway with the clinicopathological features and prognostic significance in nasopharyngeal carcinoma (NPC). The study tissues were collected from 285 patients with NPC and normal mucosal tissues were obtained from 289 individuals with normal nasopharynxes. Immunohistochemical staining was used to detected the expression of the AKT, mTOR, and p70 ribosomal S6 kinase (P70S6K) proteins. Follow-up was performed for between 8 and 60 months. Spearman’s rank correlation analysis was performed to evaluate the correlation of the expression of the AKT, mTOR, and P70S6K proteins in NPC tissues. Kaplan-Meier curves were plotted to show the survival of patients with NPC. A Cox proportional hazards model was used to explore the independent risk factors for prognosis. The expression of the AKT, mTOR, and P70S6K proteins in NPC tissues was higher than that in healthy nasopharyngeal mucosal tissues, and was correlated with T-staging, N-staging, clinical stage, distant metastasis, and differentiation. The positive expression of the AKT, mTOR, and P70S6K proteins was higher in patients with stage III/IV NPC, low differentiation, and metastasis. The survival rates of patients with NPC with AKT-positive, mTOR-positive, and P70S6K-positive expression were considerably lower than those without the expression of these proteins. Distant metastasis and the overexpression of the AKT, mTOR, and P70S6 proteins were independent risk factors for the prognosis of patients with NPC. The results obtained from this study indicated an association between the AKT/mTOR signaling pathway and the progression of NPC. The upregulation of the AKT/mTOR pathway in patients with NPC is a predictor of poor prognosis.

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Xp11.2 Translocation Renal Cell Carcinoma: Clinical Characteristics and Potential Prognostic Predictors

Disease Markers ◽

10.1155/2021/5647933 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Jie Dong ◽

Weifeng Xu ◽

Zhigang Ji ◽

Boju Pan

Keyword(s):

Risk Factors ◽

Distant Metastasis ◽

Cox Regression ◽

Fibrinogen Level ◽

Progression Free Survival ◽

Adult Patients ◽

Free Survival ◽

Independent Risk Factors ◽

Xp11.2 Translocation

Background. Xp11.2 translocation renal cell carcinoma, a rare malignancy, has a higher prevalence in children than in adults. It is relatively indolent in children but manifests with an aggressive course in adults. Clinical characteristics and prognostic studies for adult patients are scarce due to its rarity. Methods. This retrospective single-center study consecutively enrolled 24 newly diagnosed Xp11.2 translocation RCC adult patients. Clinical presentations were recorded, and baseline laboratory results and follow-up data were collected. Possible risk factors for progression-free survival and overall survival were first scanned with chi-square tests and t -tests to compare patients who suffered from progression or death with who did not. Multivariate Cox regression was further utilized to identify independent risk factors. Results. Twenty-four adult patients (median age 32, range 16-73), with a male-to-female ratio of 1 : 1, was included from April 2010 to March 2020. After follow-up for 35.7 months (+/- months), seven patients died. With univariate analysis, higher C-reactive protein-to-albumin (CRP/Alb) ratio ( p = 0.028 ), higher baseline fibrinogen ( p = 0.006 ), and presence of distant metastasis ( p = 0.007 ) were associated with progression of the disease; higher preoperative fibrinogen ( p = 0.014 ) and distant metastasis ( p = 0.020 ) were associated with death. With multivariate Cox regression, only baseline fibrinogen level ( p = 0.001 ) was identified as an independent risk factor for progression-free survival; meanwhile, fibrinogen level ( p = 0.048 ) and distant metastasis ( p = 0.043 ) were identified as independent risk factors for survival. Conclusions. Overall, relatively high CRP/Alb ratios, fibrinogen, and distant metastasis were associated with a poor prognosis of Xp11.2 tRCC adult patients; among them, only baseline fibrinogen levels independently predicted the progression of Xp11.2 tRCC; thus, it may help to identify patients with worse progression or death risk.

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A Predictive Nomogram for Red Blood Cell Transfusion in Pheochromocytoma Surgery: A Study on Improving the Preoperative Management of Pheochromocytoma

Frontiers in Endocrinology ◽

10.3389/fendo.2021.647610 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ying Guo ◽

Lili You ◽

Huijun Hu ◽

Anli Tong ◽

Xiaoyun Zhang ◽

...

Keyword(s):

Risk Factors ◽

Blood Cell ◽

Red Blood Cell ◽

Treatment Duration ◽

External Validation ◽

Red Blood Cell Transfusion ◽

Tumor Diameter ◽

Preoperative Management ◽

Good Discrimination ◽

Internal Validation

PurposeSurgery is the major treatment option for pheochromocytoma but carries potential risks, including hemorrhage and hemodynamic instability. Even with laparoscopic adrenalectomy, intraoperative blood transfusion happens from time to time, but few studies have investigated risk factors. For the first time we develop and validate a nomogram for prediction of red blood cell transfusion in pheochromocytoma surgery.MethodsThere were 246 patients in our center and 56 patients in Peking Union Medical College Hospital, who underwent pheochromocytoma surgery, enrolled in the study. We incorporated clinical and radiological risk factors, and presented this with a nomogram. Lasso regression model was used for feature selection. Logistic regression analysis was performed to identify the odd ratios. The performance of the nomogram was assessed with respect to its discrimination, calibration and clinical usefulness.ResultsThirty-two features were reduced to five, which were phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction heart rate, tumor diameter and surgical procedure. The model showed good discrimination (C-index, 0.857; 95% CI, 0.781–0.836) and application in the validation sets also gave good discrimination (internal validation: C-index, 0.831; 95% CI, 0.750–0.822; external validation: C-index, 0.924; 95% CI, 0.766–1.000). Calibration tested with the Hosmer-Lemeshow test yielded a good agreement between prediction and observation (training P=0.358; internal validation P=0.205; external validation P=0.395). Odd ratios of phenoxybenzamine use, phenoxybenzamine treatment duration, preinduction HR, tumor diameter and open surgery were 13.32 (95% CI, 1.48–197.38; P = 0.034), 1.04 (95% CI, 0.99–1.08; P = 0.092), 1.04 (95% CI, 1.01–1.08; P=0.006), 1.03 (95% CI, 1.02–1.06; P<0.001), 17.13 (95% CI, 5.18–78.79; P<0.001), respectively. Decision curve analysis demonstrated the clinical usefulness of the nomogram.ConclusionsThis study presents a nomogram that may be used to facilitate the prediction of red blood cell transfusion in pheochromocytoma surgery and help to do the preoperative management more efficiently.

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