According to previous studies, adult age, pelvic involvement, and larger tumor size were associated with poor survival in patients with ES 8, 9. In addition, the 5-year OS of metastasis patients is only 20–45%, depending on the location of metastasis 4, 7.ĮS survival is influenced by different factors, including patient age, primary tumor site, tumor size, distant metastasis, surgery, radiotherapy, and other clinically related prognostic factors 8, 9, 10, 11, 12. However, approximately 20–25% of ES patients have metastases at the time of initial diagnosis, and these patients are often resistant to intensive treatment 6. Advances in treatment such as in surgery, radiotherapy, and multi-drug chemotherapy have improved the 5-year overall survival (OS) rate of patients with localized ES from approximately 10% to nearly 75% 5. It is highly malignant and metastatic and recurs rapidly, thus its extremely poor prognosis 3, 4. It commonly occurs in the backbone of the long bones of the limbs and has a predilection for the femur, tibia, and humerus.
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First proposed by James Ewing in 1921, it is the second most common primary bone and soft tissue malignancy in children and adolescents 2. Compared with the 7th TNM staging, the nomogram consisting of these factors was more accurate for risk assessment and survival prediction in patients with Ewing’s sarcoma, thus providing a novel reliable tool for risk assessment and survival prediction in Ewing’s sarcoma patients.Įwing's sarcoma (ES) is a small round cell sarcoma originating from mesenchymal stem cells, which constitutes 10% to 15% of all bone sarcomas 1. Age, tumor size, primary site, N stage, and M stage are independent risk factors affecting the OS and CSS in Ewing’s sarcoma patients. Furthermore, the internal and external calibration curves showed good consistency between the predicted and observed values. The nomogram showed higher C-indexes than those in the TNM stage. Based on the multivariate analysis of the training cohort, a nomogram that integrated age, tumor size, primary site, N stage, and M stage was constructed ( P < 0.05).
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A total of 1120 patients were divided into training (n = 713) and validation (n = 407) cohorts. Finally, the nomogram was verified internally and externally through the training and validation cohorts, and the predictive capability was evaluated using the receiver operating characteristic (ROC) curve, C-index, and calibration curve and compared with that of the 7th TNM stage. The nomogram was used to predict 3- and 5-year overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate Cox regression analyses were used to identify meaningful independent prognostic factors. Patients diagnosed with Ewing's sarcoma were collected from the Surveillance, Epidemiology, and End Results program database between 20 and further divided into training and validation cohort. The study aimed to determine the risk factors independently associated with the prognosis of Ewing's sarcoma and to construct a nomogram to predict patient survival. Although the overall prognosis of Ewing's sarcoma has improved, the 5-year survival rate has not improved significantly.
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Ewing's sarcoma is a high-grade malignancy bone and soft tissue tumor that most commonly occurs in children and adolescents.