Optimization of Predictors of Ewing Sarcoma Cause-specific Survival: A Population Study

Background: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) Ewing sarcoma (ES) outcome data. The aim of this study was to identify and optimize ES-specific survival prediction models and sources of survival disparities. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for ES. 1844 patients diagnosed between 1973-2009 were used for this study. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome (bone and joint specific death, yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. Results: The mean follow up time (S. D.) was 74.48 (89.66) months. 36% of the patients were female. The mean (S. D.) age was 18.7 (12) years. The SEER staging has the highest ROC (S. D.) area of 0.616 (0.032) among the factors tested. We simplified the 4-layered risk levels (local, regional, distant, un-staged) to a simpler non-metastatic (I and II) versus metastatic (III) versus un-staged model. The ROC area (S. D.) of the 3-tiered model was 0.612 (0.008). Several other biologic factors were also predictive of ES-specific survival, but not the socio-economic factors tested here. Conclusions: ROC analysis measured and optimized the performance of ES survival prediction models. Optimized models will provide a more efficient way to stratify patients for clinical trials.