Risk factors for metastasis and poor prognosis of Ewing sarcoma: a population based study
Risk factors for metastasis and poor prognosis of Ewing sarcoma: a population based study
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尤文肉瘤转移和不良预后的危险因素：一项基于人群的研究
DOI：
10.1186/s13018-020-01607-8
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发表时间：
2020-03-04
影响因子：
2.6
通讯作者：
Wang, Xu
中科院分区：
文献类型：
--
作者：
Shi, Jiaqi;Yang, Jianing;Wang, Xu
背景本研究旨在确定SEER数据库中Ewing肉瘤（ES）患者转移的危险因素。探讨与预后不良相关的临床病理因素。方法在SEER数据库中收集ES患者的临床病理资料，采用卡方检验和logistic回归分析确定与转移相关的危险因素。我们还进行了生存分析，包括Kaplan-Meier曲线和Cox比例风险模型，以探索与总生存和癌症特异性生存相关的危险因素，然后开发了nomogram来可视化和量化生存概率。结果经统计发现，年龄较大的患者(11-20岁：OR = 1.517, 95%可信区间[CI] 1.033-2.228,p= 0.034； 21-30岁：OR = 1.659。95%CI 1.054 ~ 2.610,p= 0.029)，肿瘤较大（bbb8 cm: OR = 1.914, 95%CI 1.251 ~ 2.928,p= 0.003），盆腔病变（OR = 2.492, 95%CI 1.829 ~ 3.395,p< 0.001）转移风险较高。ROC曲线显示，结合这三个因素的联合模型在诊断时预测转移的AUC（0.65）较高。在生存分析中，年龄较大（11-20岁：HR = 1.549, 95%CI 1.144-2.099,p= 0.005； 21-30岁：HR = 1.808, 95%CI 1.278-2.556,p= 0.001； 31-49岁：HR = 3.481, 95%CI 2.379-5.094,p< 0.001；≥50岁：HR = 4.307, 95%CI 2.648-7.006,p< 0.001）、肿瘤较大(5-8 cm: HR = 1.386, 95%CI 1.005-1.991,p= 0.046；黑种人（HR = 2.104, 95%CI 1.296-3.416,p= 0.003）和较宽的延伸（区域：HR = 1.373, 95%CI 1.033-1.823,p= 0.029；转移性：HR = 3.259, 95%CI 2.425-4.379,p< 0.001）与较差的预后相关。化疗与预后较好相关（HR = 0.466, 95%CI 0.290 ~ 0.685,p< 0.001）。由训练集形成的以预测OS和CSS为目的的nomogram与内部和外部的实际观察结果具有良好的一致性。结论肿瘤大小和原发部位与诊断时远处转移有关。年龄、肿瘤大小、原发部位、肿瘤范围和化疗与总生存期和癌症特异性生存期相关。Nomogram可以预测OS和CSS发生的概率，与内外实际观察结果具有较好的一致性。
BackgroundThis study is to determine the risk factors for metastasis of Ewing sarcoma (ES) patients in SEER database. Then explore clinicopathological factors associated with poor prognosis. Furthermore, develop the nomogram to predict the probability of overall survival and cancer-specific survivalMethodsThus, we collected clinicopathological data of ES patients in SEER database, and then used chi-square test and logistic regression to determine risk factors associated to metastasis. We also did survival analysis including Kaplan-Meier curve and Cox proportional hazard model to explore the risk factors associated to overall survival and cancer-specific survival, and then developed the nomogram to visualize and quantify the probability of survival.ResultsAfter statistics, we find that patients with older ages (11–20 years old: OR = 1.517, 95% confidence interval [CI] 1.033–2.228,p= 0.034; 21–30 years old: OR = 1.659. 95%CI 1.054–2.610,p= 0.029), larger tumor size (> 8 cm: OR = 1.914, 95%CI 1.251–2.928,p= 0.003), and pelvic lesions (OR = 2.492, 95%CI 1.829–3.395,p< 0.001) had a higher risk of metastasis. ROC curves showed higher AUC (0.65) of combined model which incorporate these three factors to predict the presence of metastasis at diagnosis. In survival analysis, patients with older ages (11–20 years: HR = 1.549, 95%CI 1.144–2.099,p= 0.005; 21–30 years: HR = 1.808, 95%CI 1.278–2.556,p= 0.001; 31–49 years: HR = 3.481, 95%CI 2.379–5.094,p< 0.001; ≥ 50 years: HR = 4.307, 95%CI 2.648–7.006,p< 0.001) , larger tumor size (5–8 cm: HR = 1.386, 95%CI 1.005–1.991,p= 0.046; > 8 cm: HR = 1.877, 95%CI 1.376–2.561,p< 0.001), black race (HR = 2.104, 95%CI 1.296–3.416,p= 0.003), and wider extension (regional: HR = 1.373, 95%CI 1.033–1.823,p= 0.029; metastatic: HR = 3.259, 95%CI 2.425–4.379,p< 0.001) were associated with worse prognosis. Chemotherapy was associated with better prognosis (HR = 0.466, 95%CI 0.290–0.685,p< 0.001). The nomogram which developed by training set and aimed to predict OS and CSS showed good consistency with actual observed outcomes internally and externally.ConclusionIn conclusion, tumor size and primary site were associated with distant metastasis at diagnosis. Age, tumor size, primary site, tumor extent, and chemotherapy were associated with overall survival and cancer-specific survival. Nomogram could predict the probability of OS and CSS and showed good consistency with actual observed outcomes internally and externally.