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ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Oncology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1574034
Prognostic Nomogram for Overall Survival in Pediatric Osteosarcoma with Pulmonary Metastases: A SEER Database Analysis
Provisionally accepted- 1 Qingdao Women and Infants Hospital, Qingdao, China
- 2 Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, Fujian Province, China
Background: Pulmonary metastasis (PM) is the most common site of distant metastasis in osteosarcoma (OS), with pediatric cases showing poor prognosis. However, limited research has focused on identifying prognostic factors (PFs) for pediatric osteosarcoma with pulmonary metastasis (POPM). This study aims to analyze clinical features and PFs of POPM and develop a validated nomogram to predict overall survival in POPM patients. Methods: This retrospective analysis used OS cases from the SEER database (2010-2021). Clinical characteristics were compared between POPM and OS patients without PM. PFs for POPM were identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression and evaluated through Kaplan-Meier analysis. The dataset was split into training (N = 148) and validation (N = 64) groups. Independent PFs were assessed via Cox regression to construct a prognostic nomogram. The nomogram's performance was evaluated using the concordance index (C-index), AUC-ROC, and calibration plots. Decision curve analysis (DCA) was used to assess clinical applicability. Results: LASSO regression identified key PFs: AJCC stage, T stage, median household income, systemic therapy, and time from diagnosis to treatment. These were validated as independent PFs via Cox regression. The nomogram demonstrated strong predictive accuracy with C-index values of 0.68 (training) and 0.71 (validation). AUC values for 1-, 3-, and 5-year survival were 0.786, 0.709, and 0.711 (training), and 0.780, 0.760, and 0.776 (validation). Calibration plots showed excellent concordance, and DCA confirmed the nomogram's clinical relevance. Conclusion: AJCC stage, median household income, systemic therapy, and time from diagnosis to treatment are significant PFs for POPM survival. The validated nomogram is a valuable tool for clinicians, improving personalized treatment and prognostic assessment for these patients.
Keywords: Osteosarcoma, Pulmonary metastasis, prognosis, nomogram, Pediatric osteosarcoma
Received: 10 Feb 2025; Accepted: 02 Apr 2025.
Copyright: © 2025 Tang, Guo, Lu, Fang and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Weiming Chen, Department of Pediatric Surgery, Fujian Maternity and Child Health Hospital, Fuzhou, 350001, Fujian Province, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.