Interpretable clinical visualization model for prediction of prognosis in osteosarcoma: a large cohort data study

BACKGROUND: Currently, the clinical prediction model for patients with osteosarcoma was almost developed from single-center data, lacking external validation. Due to their low reliability and low predictive power, there were few clinical applications. Our study aimed to set up a clinical prediction model with stronger predictive ability, credibility, and clinical application value for osteosarcoma. METHODS: Clinical information related to osteosarcoma patients from 2010 to 2016 was collected in the SEER database and four different Chinese medical centers. Factors were screened using three models (full subset regression, univariate Cox, and LASSO) via minimum AIC and maximum AUC values in the SEER database. The model was selected by the strongest predictive power and visualized by three statistical methods: nomogram, web calculator, and decision tree. The model was further externally validated and evaluated for its clinical utility in data from four medical centers. RESULTS: Eight predicting factors, namely, age, grade, laterality, stage M, surgery, bone metastases, lung metastases, and tumor size, were selected from the model based on the minimum AIC and maximum AUC value. The internal and external validation results showed that the model possessed good consistency. ROC curves revealed good predictive ability (AUC > 0.8 in both internal and external validation). The DCA results demonstrated that the model had an excellent clinical predicted utility in 3 years and 5 years for North American and Chinese patients. CONCLUSIONS: The clinical prediction model was built and visualized in this study, including a nomogram and a web calculator (https://dr-lee.shinyapps.io/osteosarcoma/), which indicated very good consistency, predictive power, and clinical application value.