A Novel Clinical Tool to Predict Cancer-specific Survival in Postoperative Patients With Primary Spinal and Pelvic Sarcomas: A Large Population-Based Retrospective Cohort Study

Abstract

Study Design Retrospective cohort study. Objective Primary osseous sarcomas originating from the spine and pelvis are rare and usually portend inferior prognoses. Currently, the standard treatment for spinal and pelvic sarcomas is surgical resection, but the poor prognosis limits the benefits to postoperative patients. This study aims to identify the independent prognostic factors of cancer-specific survival (CSS) in postoperative patients with primary spinal and pelvic sarcomas and construct a nomogram for predicting these patients’ 3-, 5-, and 10-year CSS probability. Methods A total of 452 patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. They were divided into a training cohort and a validation cohort. Univariate and multivariate Cox regression analyses were used to identify these patients’ CSS-related independent prognostic factors. Then, those factors were used to construct a prognostic nomogram for predicting the 3-, 5-, and 10-year CSS probability, whose predictive performance and clinical value were verified by the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Finally, a mortality risk stratification system was constructed. Results Sex, histological type, tumor stage, and tumor grade were identified as CSS-related independent prognostic factors. A nomogram with high predictive performance and good clinical value to predict the 3-, 5-, and 10-year CSS probability was constructed, on which a mortality risk stratification system was constructed based to divide these patients into 3 mortality risk subgroups effectively. Conclusions This study constructed and validated a clinical nomogram to predict CSS in postoperative patients with primary spinal and pelvic sarcomas. It could assist clinicians in classifying these patients into different mortality risk subgroups and realize sarcoma-specific management.