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  • br Department of Orthopedics Guangzhou First People s Hospit

    2020-08-03


    10 Department of Orthopedics, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong 510180, People's Republic of China, E-mail: [email protected]
    11 Department of Orthopedics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, People's Republic of China, E-mail: [email protected]
    12 Department of Orthopedics, Guangzhou First People's Hospital, the Second
    Affiliated Hospital of South China University of Technology, Guangzhou, Guangdong
    510180, People's Republic of China, E-mail: [email protected]
    Corresponding and reprint requests to Shi-Feng Wen, MD, Department of
    Orthopedics, Guangzhou First People's Hospital, the Second Affiliated Hospital of
    South China University of Technology, first Pan Fu Rd, Guangzhou, Guangdong
    * Weipeng Zheng and Yuanping Huang and Tianwang Guan and Songfang Lu contributed equally to this JNJ-42153605 work.
    ACCEPTED MANUSCRIPT
    Abstract
    Background
    The survival prediction of patients with chordoma is difficult to make due to the
    rarity of this oncologic disease. Our objective was to apply a nomogram to predict
    survival outcomes in individuals with chordoma of the skull base, vertebral column,
    and pelvis.
    Methods
    A total of 558 patients with chordoma between 1973 and 2014 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors in patients with chordoma were identified via univariate and multivariate Cox analysis. Then these prognostic factors were incorporated into a nomogram to predict 3- and 5-year overall survival and cancer-specific survival rates. Internal and external data were used to validate the nomograms. Concordance indices (C-indices) were used to estimate the accuracy of this nomogram system. Results
    A total of 558 patients were randomly assigned into a training cohort (n = 372) and a validation cohort (n = 186). Age, surgical stage, tumor size, histology, primary site, and use of surgery were identified as independent prognostic factors via univariate and multivariate Cox analysis (all p<0.05) and further included to establish the nomogram. The C-indices for overall survival and cancer-specific survival prediction of the training cohort were 0.775 (95% confidence interval, 0.770 to 0.779) and 0.756 (95% confidence interval, 0.749 to 0.762). The calibration plots both showed an excellent consistency between actual survival and nomogram prediction. Conclusion
    Nomograms were constructed to predict overall survival and cancer-specific survival for patients with chordoma of the skull base, vertebral column, and pelvis. The nomogram could help surgeons to identify high risk of mortality and evaluate prognosis in patients with chordoma.
    Key words
    Cancer-specific survival, chordoma, nomogram, overall survival, SEER database
    ACCEPTED MANUSCRIPT
    Introduction
    Chordomas, which originate from remnants of the embryonic notochord, represent less than 4% of primary bone tumors [1]. Although the chordoma is a slow-growing, low-grade tumor, this aggressive tumor gradually can infiltrate nervous tissue, adjacent muscle, and related joints [2 3]. The growth of a chordoma tumor begins with bony infiltration and proceeds to invasion of endocranium and neurovascular structures [4]. A high recurrence rate can severely impact the survival rate and reduce the quality of life of patients with this tumor [5]. The location of chordomas is frequently the sacral area (55%), followed by the skull region (35%) and the vertebral column region (10%) [6]. The management of chordoma centers on radical resection when possible [3]. However, the complete surgical resection of aggressive chordomas remains formidable due to the specific location. Adjuvant radiation therapy has been proved to provide benefits in the treatment of skull-base chordomas, whereas chemotherapy has limited efficacy on most chordomas [5 7-9].
    Identifying prognostic factors for patients with chordoma is a significant part of treatment planning. Previous studies have proved that metastasis and surgical margin are independent prognostic factors for patients with chordoma [10-12]. In addition, patient age, recurrence, and tumor size have also been shown to influence patient survival [10-14]. However, single prognostic factors exert limited influence on a precise individualized prediction of prognosis. The prognostic nomogram is an efficient statistical tool that has been suggested as a new standard to predict an individual patient’s survival. And, this graphic calculating scales method has been proved to be a useful method in the management of several types of cancer [15-17]. The obvious advantages of prognostic nomograms are robustness and better predictive accuracy, which enhance its potential for the predictive accuracy of individual prognosis [17]. However, a prognostic nomogram that can be applied to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with chordoma has not been reported, and this might be ascribed to the limited number of chordoma cases in a single institution [2].