The relationship between coagulation factors and prognosis in patients with classic osteosarcoma and the construction of a predictive model

LI Tao; ZHANG Jin-yu; XIAO Yan-bin; Peng Zhuo-hui; ZHOU Rui-qi; LUO Peng-fei

doi:10.3969/j.issn.2095-252X.2025.11.006

Abstract：Objective To analyze the relationship between pre-treatment coagulation indices and prognosis in patients with first diagnosis of conventional osteosarcoma(COS),to assess its predictive value,and to construct a column-line graph model for predicting overall survival.Methods Clinical data and laboratory blood sampling indexes of 141 patients with pathological type of conventional osteosarcoma that met the NAE criteria and received treatment for the first time during the period of January 2017 to December 2022 at the Department of Orthopaedics of Yunnan Cancer Hospital were retrospectively collected,and the optimal thresholds of PT,FIB,D-D,and PLT were determined by using the analysis of the receiver operating characteristic curve(ROC),and the PT was analyzed by using chi-square test,FIB,D-D,PLT levels in relation to the clinical characteristics of the patients,and the Kaplan-Meier method and Cox proportional risk model were used to study the effects of PT,FIB,D-D,PLT on overall survival.A column-line diagram prediction model was established based on independent risk factors for patient prognosis.Results High FIB level before treatment was correlated with tumor diameter,pathological fracture,and lymph node metastasis(P<0.05),and high F-D level before treatment was correlated with tumor diameter and lymph node metastasis(P<0.05).The 3-year survival rate and mean overall survival of the group with high PT,FIB,D-D,and PLT levels were lower than those of the group with low PT,FIB,D-D,and PLT levels(3-year survival rate:47.20%,50.07%,48.80%,and 49.00%vs.66.70%,67.10%,70.08%,and 64.80%;mean overall survival:41.70 months,42.09 months,42.90 months,51.77 months vs.59.52 months,62.92 months,64.35 months,53.87 months;the difference in overall survival between the two groups was statistically significant).The results of univariate Cox regression analysis showed that lung metastasis,tumor diameter,Enneking stage,PT,FIB,D-D,and PLT levels were correlated with overall survival(P<0.05),and the results of multivariate Cox regression analysis showed that lung metastasis,FIB,and D-D levels were independent risk factors affecting the prognosis of COS patients.A column-line diagram was constructed based on the independent risk factors screened by the Cox regression model,and the C-index(C-index)suggested that the model had a good predictive performance,which was known to have good accuracy by the prediction model calibration curve.Conclusions The prognosis of COS patients with high pre-treatment PT,FIB,D-D,and PLT levels is poor,and the prediction model constructed on the basis of pre-treatment FIB,D-D levels,and lung metastasis has a good predictive efficacy,which could guide the diagnosis and treatment of COS patients.