BackgroundOsteosarcoma (OS) is the primary malignant bone tumor that most commonly affects children and adolescents. Recent years effective chemotherapy have improved the 5-year survival in osteosarcoma patients to up to 60%-70%. Still, there is a lack of novel therapeutic strategies to enhance further survival. Our study aimed to evaluate the clinical significance of pretreatment inflammatory-based parameters, including PLT, NLR, and SII, as prognostic indicators of survival in pediatric osteosarcoma patients.MethodsA total of 86 pediatric osteosarcoma patients between 2012 and 2021 in the Department of Orthopedics or tumor Surgery of Children's Hospital affiliated to Chongqing Medical University were retrospectively analyzed. The clinicopathological variables and systematic inflammatory biomarkers, including NLR, PLR and SII, was performed by the A Receiver operating characteristic (ROC) curve and Cox proportional risk regression model. According to the results of multivariate analysis, a prognostic nomogram was generated, and the concordance index (C-index) was calculated to predict the performance of the established nomogram. The survival curve was plotted by the Kaplan-Meier method.ResultsUnivariate analysis showed that TNM stage, tumor size, NLR value, PLR value, SII value, neutrophil count and platelet count were related to CSS (p < 0.05). According to multivariate analysis, only TNM stage (p = 0.006) and SII values (p = 0.015) were associated with poor prognosis.To further predict survival in pediatric osteosarcoma patients, multivariate Cox regression analysis was used to predict cancer-specific survival at 1, 3 and 5 years. And constructed a nomogram model to predict children's CSS. The C-index of the nomogram is 0.776 (95%CI, 0.776–0.910), indicating that the model has good accuracy.ConclusionPreoperative SII and TNM staging are independent prognostic markers for pediatric osteosarcoma patients. SII may be used in conjunction with TNM staging for individualized treatment of pediatric osteosarcoma patients in future clinical work.

Background Most malignant bone tumors in children and adolescents are osteosarcomas. Pediatric osteosarcoma has a high mortality rate due to pulmonary metastasis, which occurs in a short period of time. We would like to establish a nomogram to predict the risk of pulmonary metastasis of pediatric osteosarcoma to help doctors conduct early intervention and and improve their survival rate. Methods The clinicopathological information of patients was downloaded from SEER to identify pediatric osteosarcoma from 2004 to 2018. We analyzed the independent risk factors for pulmonary metastasis of pediatric osteosarcoma in the training cohort using univariate and multivariate logistic regression. Using these risk factors, we established a Nomogram prediction for pulmonary metastasis of pediatric osteosarcoma. We used three indicators to evaluate the accuracy of the nomogram. These three were calibration curve, c-index and area under the receiver operating curve (AUC). The clinical value of this nomogram was evaluated using Decision curve analysis (DCA). Results A sum of 1362 pediatric patients with osteosarcoma were involved in this research. They were randomly divided into the training cohort (N = 965) and the validation cohort (N = 397). In training cohort, univariate and multivariate logistic regression analysis showed that there were four independent risk factors, namely T stage, N stage, surgery, and radiotherapy. We constructed a new Nomogram to predict the risk of pulmonary metastasis in pediatric osteosarcoma. In the training cohorts and validation cohorts, the C-index was 0.699 (95% CI, 0.656–0.741) and 0.736 (95% CI, 0.675–0.797),respectively, indicating that the nomogram had good accuracy. The AUC of training group and validation group showed good predictive ability. Conclusion This study constructed a new nomogram to predict the risk of pulmonary metastasis in pediatric osteosarcoma. Our nomogram can help doctors provide accurate assessment of individual risk, active monitoring and follow-up of patients, and prevent pulmonary metastasis in pediatric osteosarcoma.