title: A probabilistic analysis of completely excised high-grade soft tissue sarcomas of the extremity: an application of a Bayesian belief network.
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.
authors.affiliation: Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD, USA. jaforsberg@me.com
authors.forename: Jonathan Agner
authors.initials: JA
authors.lastname: Forsberg
authors.forename: John H
authors.initials: JH
authors.lastname: Healey
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001499:Bayes Theorem; D017024:Chemotherapy, Adjuvant; D003198:Computer Simulation; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D012372:ROC Curve; D012509:Sarcoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D034941:Upper Extremity