Table 3.
Histology-Specific and Histology-Specific and Site-Specific Nomograms for Patients With STS.
| Study | Development Series Characteristics | Nomogram Details | Internal Validation | External Validation | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Selection Criteria | Timeframe | No. of Centers | Predicted Outcomes | No. of Patients | Nomogram’s Covariates (a) | Concordance Index | Yes/No | Concordance Index | ||
| Liposarcoma | Dalal [55] 2006 | Nonmetastatic liposarcoma of the extremity, trunk, or retroperitoneum | 1982–2005 | 1 | 5-y and 12-y DSS | 801 | Histology (5 categories), tumor burden (continuous), age (continuous), surgical resection margins (R0 vs. R1 vs. R2), site (5 categories), presentation status (prior excision vs. biopsy vs. no treatment), tumor depth (superficial vs. deep), sex (male vs. female) | 0.83 | No | |
| Synovial sarcoma | Canter [57] 2008 | Primary, localized, surgically treated patients with synovial sarcoma who did not receive AI chemotherapy | 1982–2006 | 1 | 3-y and 5-y DSS | 196 | Size (continuous), site (upper extremity vs. lower extremity vs. others), depth (superficial vs. deep), variant (biphasic vs. monophasic) | 0.77 | No | - |
| Rhabdomyo-sarcoma | Yang [60] 2014 | Patients with primary RMS (both localized or metastatic) and aged birth to 19 y | 1990–2010 | SEER database (populationbaseddata set) |
5-y and 10-y OS, median survival time | 1679 | Tumor stage (localized vs. regional vs. distant), surgery (yes vs. no), RT (yes vs. no), size (continuous), histological subtype (alveolar vs. embryonal vs. others), age (continuous), tumor site (favorable vs. unfavorable) | 0.74 | No | |
| Shen [61] 2014 | Patients with primary RMS treated with surgery (all ages) | 1990–2010 | SEER database (populationbaseddata set) |
5-y and 10-y causespecific survival and median survival time for patients treated with surgery alone or with surgery plus RT | 1578 | Age (continuous), size (continuous), stage (localized vs. regional vs. distant), histological subtype (embryonal vs. alveolar vs. pleomorphic vs. others), positive regional lymph nodes (no lymph nodes examined vs. 0 vs. 1–3 vs. 4) | 0.78 | No | ||
| Chisholm [59] 2011 | Children with nonmetastatic RMS and embryonal RMS who developed disease recurrence after achieving complete local control (complete remission or stable mass for >6 mo after the end of therapy) with primary therapy | 1984–2003 (primary treatment) | Multicentric (international registry) | Probability of cure defined as survival 3.0 y after disease recurrence | 474 | Type of recurrence (local vs. metastatic 6 local), prior RT (yes vs. no), type of chemotherapy (2-drug vs. 3-drug vs. 6-drug), lymph node status (N0 vs. N1 vs. Nx), tumor size (missing vs. <5 cm vs. >5 cm), tumor site (favorable vs. unfavorable), histology (alveolar vs. nonalveolar), time to disease recurrence (>1.5 y vs. <1.5 y) | No | |||
| Desmoid-type fibromatosis | Crago [64] 2013 | Surgically treated desmoid-type fibromatosis | 1982–2011 | 1 | 3-y, 5-y, and 7-y LRFS and median time to LR | 495 | Age (continuous), tumor site (extremity vs. chest wall vs. GI/intrabdominal vs. other vs. abdominal wall), size (continuous) | 0.70 | Yes | 0.66 (b) |
| Breast phyllodes tumors | Tan [67] 2012 | Surgically treated phyllodes tumors of the breast | 1992–2010 | 1 | 1-y, 3-y, 5-y, and 10-y RFS | 552 | Surgical resection margin (negative vs. positive), mitosis per 10 high-power fields (continuous), atypia (marked vs. moderate vs. mild), overgrowth (present vs. absent) | 0.79 | No | |
| Uterine leiomyo-sarcoma | Zivanovic [68] 2012 | Surgically treated uterine leiomyosarcoma | 1982–2008 | 1 | 5-y OS | 185 | Mitotic index (continuous), tumor grade (high vs. not high), locoregional metastasis (yes vs. no), distant metastasis (yes vs. no), tumor size (continuous), cervical involvement (yes vs. no), age at diagnosis (continuous) | 0.67 | Yes | 0.67 (c) |
Abbreviations: AI, anthracycline-ifosfamide; DSS, disease-specific survival; GI, gastrointestinal; LR, local recurrence; LRFS, local recurrence-free survival; OS, overall survival; RFS, recurrence-free survival; RMS, rhabdomyosarcoma; RT, radiotherapy; SEER, Surveillance, Epidemiology, and End Results; STS, soft tissue sarcoma. (a) The variables are listed according to their nomogram score range, which reflects their relative effect on the predicted outcome, on a decreasing basis (the first variable exerts the strongest influence on the predicted outcome). (b) External validation was performed on 274 patients with desmoid-type fibromatosis who underwent complete surgical resection in 24 cancer centers from the French Sarcoma Group (Harrell C-index, 0.659, [95% confidence interval, 0.598–0.712] [54]. (c) External validation was performed on 187 patients treated with hysterectomy between 1994 and 2010 at Brigham and Women’s Hospital/Dana-Farber Cancer Institute in Boston, Massachusetts, and the European Institute of Oncology in Milan, Italy (Harrell C-index, 0.67 [95% confidence interval, 0.62–0.72]) [57].