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Background:  This study aimed to construct a clinical prediction model for osteosarcoma patients to evaluate the influence factors for the occurrence of lymph node metastasis (LNM).   Methods:  In our retrospective study, a total of 1,256 patients diagnosed with chondrosarcoma were enrolled from the SEER (Surveillance, Epidemiology, and End Results) database (training cohort,  n  = 1,144) and multicenter dataset (validation cohort,  n  = 112). Both the univariate and multivariable logistic regression analysis were performed to identify the potential risk factors of LNM in osteosarcoma patients. According to the results of multivariable logistic regression analysis, A nomogram were established and the predictive ability was assessed by calibration plots, receiver operating characteristics (ROCs) curve, and decision curve analysis (DCA). Moreover, Kaplan-Meier plot of overall survival (OS) was plot and a web calculator visualized the nomogram.   Results:  Five independent risk factors [chemotherapy, surgery, lung metastases, lymphatic metastases (M-stage) and tumor size (T-stage)] were identified by multivariable logistic regression analysis. What's more, calibration plots displayed great power both in training and validation group. DCA presented great clinical utility. ROCs curve provided the predictive ability in the training cohort (AUC = 0.805) and the validation cohort (AUC = 0.808). Moreover, patients in LNN group had significantly better survival than that in LNP group both in training and validation group.   Conclusion:  In this study, we constructed and developed a nomogram with risk factors, which performed well in predicting risk factors of LNM in osteosarcoma patients. It may give a guide for surgeons and oncologists to optimize individual treatment and make a better clinical decision.

The Construction and Development of a Clinical Prediction Model to Assess Lymph Node Metastases in Osteosarcoma