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A Probabilistic Analysis of Completely Excised High-grade Soft Tissue Sarcomas of the Extremity: An Application of a Bayesian Belief Network

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

It is important to understand the relative importance of prognostic variables in patients with soft tissue sarcomas. The purpose of this study was to describe the hierarchical relationships between features inherent to completely excised, localized high-grade soft tissue sarcomas of the extremity and compare the associations to those previously reported.

Methods

Data were collected from the Memorial Sloan-Kettering Cancer Center Sarcoma Database. All adult patients with high-grade extremity soft tissue sarcomas who underwent complete excision (R0 margins) at our institution between 1982 and 2010 were included in the analysis. Bayesian belief network (BBN) modeling software was used to develop a hierarchical network of features trained to estimate the likelihood of disease-specific survival. Important relationships depicted by the BBN model were compared to those previously reported.

Results

The records of 1318 consecutive patients met the inclusion criteria, and all were included in the analysis. First-degree associates of disease-specific survival were the primary tumor size; presence of and time to distant recurrence; and presence of and time to local recurrence. On cross-validation, the BBN model was sufficiently robust, with an area under the curve of 0.94 (95 % confidence interval 0.93–0.96).

Conclusions

We successfully described the hierarchical relationships between features inherent to patients with completely excised high-grade soft tissue sarcomas of the extremity. The relationships defined by the BBN model were similar to those previously reported. Cross-validation results were encouraging, demonstrating that BBN modeling can be used to graphically illustrate the complex hierarchical relationships between prognostic features in this setting.

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Acknowledgment

We thank Lionel Santibáñez for his superb editorial assistance, Mithat Gönen, PhD, for his timely statistical advice, and Nicole Moraco for helpful data assembly. Supported in part by the U.S. National Cancer Institute (Soft Tissue Sarcoma Program Project (grant P01 CA047179) and the Maynard Limb Preservation Fund.

Disclosure

There are no potential conflicts of interest.

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Authors and Affiliations

  1. Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, USA

    Jonathan Agner Forsberg MD

  2. Section of Orthopaedics and Sports Medicine, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

    Jonathan Agner Forsberg MD

  3. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    John H. Healey MD & Murray F. Brennan MD

  4. Weill Medical College of Cornell University, New York, NY, USA

    John H. Healey MD & Murray F. Brennan MD

Authors
  1. Jonathan Agner Forsberg MD
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  2. John H. Healey MD
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  3. Murray F. Brennan MD
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Corresponding author

Correspondence to Jonathan Agner Forsberg MD.

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Forsberg, J.A., Healey, J.H. & Brennan, M.F. A Probabilistic Analysis of Completely Excised High-grade Soft Tissue Sarcomas of the Extremity: An Application of a Bayesian Belief Network. Ann Surg Oncol 19, 2992–3001 (2012). https://doi.org/10.1245/s10434-012-2345-z

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  • DOI: https://doi.org/10.1245/s10434-012-2345-z

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