| 64 | 0 | 113 |
| Downloads | Citas | Reads |
Objective: To construct a prediction model for determining the nature of pulmonary nodules in osteosarcoma patients based on clinical and serological indicators, with the aim of assisting clinical decision-making. Methods: This retrospective study included 98 osteosarcoma patients with solitary pulmonary nodules who were admitted to the First Affiliated Hospital of Fujian Medical University between December 2012 and December 2024. Patient age, sex, tumor location and volume, as well as levels of C-reactive protein(CRP), erythrocyte sedimentation rate(ESR), lactate dehydrogenase(LDH), and alkaline phosphatase(ALP) were collected. Variables for the model were screened using LASSO regression, and the prediction model was subsequently constructed via multivariable logistic regression. The model was presented as a nomogram and its performance was comprehensively evaluated via the receiver operating characteristic(ROC) curve analysis, calibration curve, concordance index(C-index), and decision curve analysis(DCA). Internal validation was performed using the Bootstrap resampling method with 1, 000 repetitions. Results: Five predictive variables were ultimately identified: patient age, CRP, ESR, LDH, and ALP. The constructed nomogram-based prediction model demonstrated excellent predictive performance, with an area under the ROC curve(AUC) of 0.815 and a C-index of 0.815 [95% confidence interval(95%CI): 0.720-0.910]. The calibration curve indicated that the predicted results of the model were highly consistent with the actual outcomes. DCA confirmed that the model's clinical utility within a threshold probability range of 0.06 to 0.64, indicating a net benefit for patients. Internal validation using the Bootstrap resampling further supported the reliability of the model(C-index=0.833). Conclusions: The prediction model for the nature of pulmonary nodules based on patient age, CRP, ESR, LDH, and ALP can intuitively estimate the probability that a pulmonary nodule in osteosarcoma patients represents lung metastasis, and demonstrates good clinical decision-making value.
[1]Bishop MW. Osteosarcoma:diagnosis, treatment, and emerging opportunities[J]. Hematol Oncol Clin North Am,2025, 39(4):749-760.
[2]Mettmann VL, Blattmann C, Friedel G, et al. Primary multisystemic metastases in osteosarcoma:presentation, treatment, and survival of 83 patients of the Cooperative Osteosarcoma Study Group[J]. Cancers(Basel), 2024, 16(2):275.
[3]Reinecke JB, Jimenez Garcia L, Gross AC, et al. Aberrant activation of wound-healing programs within the metastatic niche facilitates lung colonization by osteosarcoma cells[J].Clin Cancer Res, 2025, 31(2):414-429.
[4]Bashir A, Ismail A, Mavadia A, et al. Pathobiology and molecular pathways implicated in osteosarcoma lung metastasis:a scoping review[J]. Technol Cancer Res Treat, 2025,24:15330338251359716.
[5]Seiden EE, Richardson SM, Everitt LA, et al. Repurposing romidepsin for osteosarcoma:screening FDA-approved oncology drugs with three-dimensional osteosarcoma spheroids[J]. bioRxiv, 2025.
[6]Thiel DD, Jorns J, Lohse CM, et al. Maximum tumor diameter is not an accurate predictor of renal cell carcinoma tumor volume[J]. Scand J Urol, 2013, 47(6):472-475.
[7]MacMahon PJ, Kennedy AM, Murphy DT, et al. Modified prostate volume algorithm improves transrectal US volume estimation in men presenting for prostate brachytherapy[J].Radiology, 2009, 250(1):273-280.
[8]Cander S, Oz Gul O, Eylemer E, et al. Comparison of the effects of medical and surgical treatments in giant prolactinoma:a single-center experience[J]. Hormones(Athens),2021, 20(3):491-498.
[9]Wei J, Liang Z, Xu G. Analysis of clinical manifestations and prognostic factors affecting osteosarcoma[J]. Dis Markers, 2022:1599112.
[10]Weitao Y, Xinhui D, Zhehuang L, et al. Multiple Indeterminate pulmonary nodules(IPNs)as independent prognostic indicators in pediatric osteosarcoma:a ten-year retrospective study[J]. J Bone Oncol, 2025, 52:100674.
[11]Ahmed G, Elshafiey M, Romeih M, et al. The prognostic value of the central location of pulmonary nodules in osteosarcoma patients[J]. Discov Oncol, 2025, 16(1):705.
[12]Tang J, Guo Y, Lu H, et al. Prognostic nomogram for overall survival in pediatric osteosarcoma with pulmonary metastases:a SEER database analysis[J]. Front Pediatr, 2025,13:1574034.
[13]Lu Y, Zhang J, Chen Y, et al. Novel immunotherapies for osteosarcoma[J]. Front Oncol, 2022, 12:830546.
[14]Xu F, Yan J, Peng Z, et al. Comprehensive analysis of a glycolysis and cholesterol synthesis-related genes signature for predicting prognosis and immune landscape in osteosarcoma[J]. Front Immunol, 2022, 13:1096009.
[15]Tian ZC, Wang JQ, Ge H. Apatinib ameliorates doxorubicin-induced migration and cancer stemness of osteosarcoma cells by inhibiting Sox2 via STAT3 signalling[J]. J Orthop Translat, 2020, 22:132-141.
[16]Niu J, Yan T, Guo W, et al. The COPS3-FOXO3 positive feedback loop regulates autophagy to promote cisplatin resistance in osteosarcoma[J]. Autophagy, 2023, 19(6):1693-1710.
[17]Kondo H, Tazawa H, Fujiwara T, et al. Osteosarcoma cellderived CCL2 facilitates lung metastasis via accumulation of tumor-associated macrophages[J]. Cancer Immunol Immunother, 2025, 74(7):193.
[18]Liu W, Zhao Y, Wang G, et al. TRIM22 inhibits osteosarcoma progression through destabilizing NRF2 and thus activation of ROS/AMPK/mTOR/autophagy signaling[J]. Redox Biol, 2022, 53:102344.
[19]Palmer EP, Cronise KE, Haines LA, et al. Osteosarcoma exosome priming of primary human lung fibroblasts induces an immune modulatory and protumorigenic phenotype[J]. Cancer Res Commun, 2025, 5(4):594-608.
[20]Ji Z, Shen J, Lan Y, et al. Targeting signaling pathways in osteosarcoma:mechanisms and clinical studies[J]. MedComm(2020), 2023, 4(4):e308.
[21]Aoki Y, Kobayashi KJ, Varshney N, et al. Precise and facile endotracheal lung-tumor-implantation mouse model visualized by GFP expression[J]. In Vivo, 2023, 37(4):1477-1481.
[22]Ogura K, Morizane C, Satake T, et al. Incidence and ageand site-specific characteristics of osteosarcoma:a population-based study using National Cancer Registry2016-2019[J]. Jpn J Clin Oncol, 2025, 55(9):1037-1045.
[23]Wiratnaya IGE, Ismail MD, Raditya RH, et al. High levels of systemic inflammatory markers associated with metastasis incidence in osteosarcoma[J]. Rev Bras Ortop(Sao Paulo), 2025, 60(3):s00451810032.
[24]Eisenberg M, Deboever N, Hofstetter WL, et al. Pulmonary surgical margins for metastatic osteosarcoma:is negative margin enough?[J]. Ann Thorac Surg, 2025, 119(3):616-624.
[25]Wang D, Liu F, Li B, et al. Development and validation of a prognostic model for overall survival in patients with primary pelvis and spine osteosarcoma:a population-based study and external validation[J]. J Clin Med, 2023, 12(7):2521.
[26]Robinson MJ, Davis EJ. Neoadjuvant chemotherapy for adults with osteogenic sarcoma[J]. Curr Treat Options Oncol, 2024, 25(11):1366-1373.
[27]Wang Z, Wang Z, Wang R, et al. Whole-exome evolutionary profiling of osteosarcoma uncovers metastasis-related driver mutations and generates an independently validated predictive classifier[J]. J Transl Med, 2025, 23(1):746.
Basic Information:
China Classification Code:R738.1
Citation Information:
[1]ZHANG Jiayu,HUANG Qingshan,LIANG Fude ,et al.Construction and internal validation of a prediction model for the nature of pulmonary nodules in osteosarcoma based on clinical and serological indicators[J].Chinese Journal of Bone and Joint Surgery,2025,18(12):1072-1078.
Fund Information:
福建省自然科学基金（2023J05135）; 福建省卫健委科技计划项目（2024CXA029）; 福建医科大学附属第一医院人才引进项目（YJRC4008）
2025-12-15
2025-12-15