軟骨芽細胞性骨肉腫における術後化学療法の生存転帰への影響と全生存期間予測のためのノモグラム

The analysis of chondroblastic osteosarcoma (CBO) was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019).​ A cohort of 317 surgically treated CBO patients was analyzed, with 261 (82.3%) receiving adjuvant chemotherapy and 56 (17.7%) classified as no/unknown chemotherapy recipients. The median diagnosis year of CBO patients was 2005 and the median follow-up time was 5.25 years (63 months).​​ Kaplan-Meier analysis demonstrated that chemotherapy significantly improved overall survival (OS) (P = 0.011), a finding corroborated after propensity score matching (P = 0.036). Specifically, the 5-year, 10-year, and 15-year overall survival(OS) of patients who received chemotherapy were 52.11%, 35.25%, and 25.29%, respectively. In contrast, the corresponding survival rates of patients who did not receive chemotherapy or whose chemotherapy status was unknown were 48.21%, 39.29%, and 25.00%, respectively. Subgroup analyses revealed enhanced chemotherapy efficacy in males (HR = 0.48, P = 0.01), high grade tumors (HR = 0.54, P = 0.015), and high income patients (HR = 0.35, P = 0.001), while ​stage stratified analysis showed that the overall survival benefit of chemotherapy was limited to patients with stage I-II disease (P for interaction = 0.008). Further interaction analysis revealed that the survival benefit of chemotherapy in patients with stage III-IV disease was significantly attenuated compared to those with stage I-II disease (HR = 0.06, P = 0.049), indicating a pronounced stage dependent effect. Multivariate Cox regression identified age, tumour stage and radiotherapy as independent prognostic factors. The constructed nomogram integrating these factors with marital status and chemotherapy achieved C-indices of 0.674 (training set) and 0.691 (validation set). Notably, it exhibited strong discriminative ability with AUC values of 0.672, 0.658, and 0.657 for predicting 5-, 10-, and 15-year OS in the training set, and even higher values of 0.741, 0.712, and 0.745 in the validation set. This tool provides individualized 5-, 10-, and 15-year OS predictions, addressing critical gaps in CBO specific prognostic assessment and supporting personalized therapeutic decision making.