Nomograms for Predicting Survival and Distant Metastasis After Resection of Localized Soft-Tissue Sarcoma of the Extremities
As reported in The Lancet Oncology, Callegaro et al have developed nomograms to predict overall survival and risk of distant metastases in patients undergoing resection of soft-tissue sarcomas of the extremities.
Study Details
The study involved data from a development cohort of 1,452 consecutive patients who had surgery at the Istituto Nazionale Tumori, Milan, between January 1994 and December 2013 and 3 validation cohorts from Institut Gustave Roussy, Villejuif (420 patients between January 1996 and May 2012), Mount Sinai Hospital, Toronto (1,436 patients between January 1994 and December 2013), and the Royal Marsden Hospital, London (444 patients between January 2006 and December 2013). The nomogram for overall survival was developed using a Cox multivariable model and that for distant metastases was developed using a Fine and Gray multivariable model. A backward procedure was used for variable selection in both.
Nomogram Discriminative Ability
In the development cohort, 10-year overall survival was 72.9%, and the 10-year crude cumulative incidence of distant metastases was 25.0%. The overall survival nomogram included age, tumor size, La Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade, and histologic subtype. The Harrel C index for discrimination using the nomogram was 0.767 in the development cohort and 0.698 in the French, 0.775 in the Canadian, and 0.762 in the UK validation cohorts.
The nomogram for distant metastases included the same variables except for patient age. The Harrel C index was 0.759 in the development cohort and 0.652, 0.744, and 0.749 in the French, Canadian, and UK validation cohorts, respectively.
The investigators concluded: “Our nomograms are reliable prognostic methods that can be used to predict overall survival and distant metastases in patients after surgical resection of soft-tissue sarcoma of the extremities. These nomograms can be offered to clinicians to improve their abilities to assess patient prognosis, strengthen prognosis-based decision making, enhance patient stratification, and inform patients in the clinic.”
Alessandro Gronchi, MD, of Fondazione IRCCS Istituto Nazionale dei Tumori, is the corresponding author of The Lancet Oncology article.
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