What are the predominant factors predicting downtrend post-traumatic growth for patients after bone tumour surgery?

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Ying Liu, Xiaofeng Zheng, Peifang Li, Yitian Wang, Jie Wang, Chongqi Tu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7084287/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Aim To investigate the predominant factors predicting downtrend post-traumatic growth for patients after bone tumour surgery. Methods We conducted a longitudinal observational study with convenience sampling. Follow-up examinations were conducted every two weeks over a total follow-up period of one month. PTG levels were measured using the Chinese version of the Post Traumatic Growth Inventory (PTGI-C). Latent Category Growth Model (LCGM) was applied to explore the latent trajectory categories of PTG. Univariate and multivariate analyses were conducted to explore the predictors and influencing factors for patients with different trajectories. Clinical trial number: ChiCTR2300074170 (Registration Date: 1st August 2023) Results A total of 153 patients were included in the study, and 141 patients completed the follow-up. The means of PTGI-C at different monitoring time were 41.24 ± 21.94, 44.56 ± 23.33, and 40.69 ± 22.63, respectively. Repeated measures analysis of variance with Univariate revealed statistically significant differences in PTGI-C across different time (F = 3.372, P = 0.02). Patients were categorized into two latent subgroups: an increasing group (intercept = 44.276, slope = 5.152, P < 0.001) and a decreasing group (intercept = 35.164, slope = − 4.718, P < 0.001) based on two-category LCGM model. Logistic regression analysis results indicated that being unmarried (OR = 0.381, P = 0.019), low level of post-traumatic symptoms (OR = 2.666, P = 0.015) which was the most influential, giant cell tumour (OR = 0.223, P = 0.047), fibrogenic tumours (OR = 0.127, P = 0.007), cartilaginous origin tumour (OR = 0.194, P = 0.034), and other tumours (OR = 0.169, P = 0.023) were predictive factors for the PTG trajectory. Conclusion The classification of PTG change trajectory suggested different positive psychological processes in patients with bone tumours. Identifying the influencing factors of patients in the PTG decline trend group can guide nurses to provide effective intervention in time. Bone tumour Influencing factors Postoperative period Post traumatic growth Post traumatic stress Surgery Figures Figure 1 Background Bone tumours, which encompass diverse mesenchymal tumours originating from bone, cartilage, and connective tissues, represent a highly heterogeneous group ranging from indolent to aggressive and metastatic [ 1 , 2 ]. These tumours were relatively rare, accounting for 2% of all human neoplasms. According to the 2022 Cancer Statistics report, there were an estimated 3,910 new cases of bone and joint cancers in the United States, resulting in 2,100 deaths [ 3 ]. Notably, advancements in treatment have placed the management of this disease on the brink of progress, leading to improved survival outcomes for patients with bone tumours [ 4 – 6 ]. The 5-year overall survival rate for individuals with malignant bone tumours has significantly increased, with current rates ranging from 65–70%, a substantial improvement from the previous rate of 20% [ 5 , 7 ]. Surgery was a crucial component of treatment for nearly all bone tumour patients, involving limb salvage and reconstruction techniques utilizing modular tumour endoprostheses [ 8 – 11 ]. In cases where the disease progresses following primary treatment, the panel recommends considering radiotherapy and/or primary site surgery to address local control or provide palliative care [ 11 ]. However, surgery itself was a traumatic procedure, characterized by a sizable incision and associated risks of complications (approximately 15.4%~27.27%), such as periprosthetic joint infection, periprosthetic bone fracture, and wound infection [ 8 , 12 , 13 ]. Additionally, patients underwent long-term rehabilitation exercises following surgery [ 8 , 12 , 13 ]. Some of them would experience the impaired body image, perceived control, and self-esteem problems after surgery [ 14 – 17 ]. In particular, patients with malignant bone tumours such as osteosarcoma often experience severe physical and mental burden when facing the dramatic changes in body image caused by amputation [ 14 , 15 ] They often adopt avoidant coping strategies and tend to be socially isolated [ 14 ]. Malignant bone tumour patients often underwent chemotherapy/radiotherapy following surgery, which frequently led to adverse reactions like nausea, vomiting, and bone marrow suppression [ 18 – 21 ]. These side effects, especially from chemotherapy significantly impacted patient comfort and gave rise to a range of psychological problems, thereby diminishing quality of life and impeding the recovery process [ 19 – 21 ]. A great number of patients with cancer were prone to experiencing psychological disturbances with high prevalence rates during the treatment. Fauske et al conducted a longitudinal study of 18 survivors with bone tumours found that only three participants felt they returned to a life similar to that before their illness, while 15 believed that their lives and bodies had undergone significant changes, with five falling into both psychological and physiological distress, experiencing decreased physical comfort and increased pain[ 15 ]. Luzzati et al. investigated the psychological status of 149 postoperative spinal tumour patients, and found that 49 participants had depressive symptoms (constituting 32.9%), among which 24 (constituting about 49.0%) were mildly depressed, six (constituting about 12.5%) were moderately depressed, and 18 (constituting about 37.5%) were severely depressed [ 16 ]. Negative emotions can affect the patient’s recovery process, and there was a possibility of inducing certain adverse reactions or complications which would impair quality of life [ 22 , 23 ]. After experiencing a series of medical interventions such as diagnosis and treatment, patients not only experience negative psychological states, including the mental health problems but also positive changes or growth, such as mental wellbeing [ 24 ]. Positive psychology was a science that focused on human virtues, strengths, and other positive qualities, and studies positive emotional experiences, cognitive processes, personality traits, creativity, talent development, and other related topics [ 25 ]. Post-traumatic growth (PTG) was a part of positive psychology. It referred to the collection of psychological positive changes experienced by individuals after struggling with traumatic events or situations, first proposed by American scholars Tedeschi and Calhoun in 1996 [ 24 ]. The factors related to PTG mainly focused on demographic characteristics, personality traits, coping strategies, and others [ 26 ]. At the same time, research has also found that individual positive psychology, such as PTG, were supposed to improve their post-traumatic status and promote positive changes in both physical and mental health [ 27 ]. The population of cancer patients who experienced PTG had a better prognosis, with significantly higher quality of life and disease recovery compared to those who did not experience PTG [ 28 , 29 ]. At present, the research on the psychological status of patients with bone tumour mainly focuses on the incidence of mental health problems, such as anxiety and depression, and the influencing factors of each negative psychological state [ 16 ]. At the same time, the relationship between psychological status and rehabilitation was also reported, but it did not focus on the psychological status and positive changes in the short term after surgery [ 23 ].Therefore, from the perspective of positive psychology, this study took the functional description model of post-traumatic growth as the theoretical basis for in-depth exploration which was analysed from four dimensions: demographic characteristics of patients, the impact of surgery on individuals, individual coping traits and somatic symptoms (pain) [ 30 ]. Considering the heterogeneity of the bone tumour patient population, the latent class growth model was used to analyse the level and change trajectory categories of post-traumatic growth of different patients after surgery. The predictors of different trajectory categories were also explored by multilevel models. This study planned to show the level of mental wellbeing of bone tumour patients after surgery and guide healthcare workers (HCWs) to identify bone tumour patients with low level of PTG and its predictive factors and carry out targeted and timely intervention. Materials and Methods Study design and participants Our study employed a longitudinal observational design. Participants were bone tumour patients attending the orthopaedics medicine outpatient clinic at a tertiary care hospital. The subjects were selected using convenience sampling. Follow-up examinations, including telephone or WeChat interviews, as well as physical examinations at the Outpatients Department, were conducted every two weeks. Data were collected at four time points: three days before surgery (T1), two days after surgery (T2), 15 days after surgery (T3), and 30 days after surgery (T4). The total follow-up period lasted one month. The study included participants who were diagnosed with primary bone tumours and underwent tumour resection between December 2019 and December 2020. Inclusion criteria required participants to have clear consciousness and no communication impairment. Patients were asked for basic information before giving out questionnaires. Patients were conscious if they answered truth-fully and accurately their personal information. Exclusion criteria were as follows: (1) mental illness or cognitive impairment that hindered cooperation with the research, and (2) concurrent heart, liver, renal insufficiency, or other malignant diseases. During the follow-up period, participants were excluded if they underwent re-operation due to disease deterioration, were influenced by other major stress events, withdrew from the study prematurely, or had more than 20% data loss. The main outcome measure in this study was a continuous variable, for which the sample size was calculated using the following formula. n = [(Z α/2 + Z β ) * σ / Δ] ² Z α/2 was set at 1.96, and Z β was set at 1.28. Based on preliminary pilot testing, the estimated value for σ was determined to be 10, while Δ was set at 3. The sample size was then computed using PASS15.0 software, resulting in a required sample size of 117 participants. Accounting for an anticipated attrition rate of 20%, the sample was expanded to 146 participants. Ethical considerations were upheld throughout the study, adhering to the principles outlined in the Declaration of Helsinki. The study received approval from the West China Hospital Ethics Committee and all participants provided informed consent by signing consent forms. This study has been registered on https://www.clinicaltrials.gov/ . with the number of ChiCTR2300074170 (Date: 1st August 2023). Measurement Patients were asked to fill out several questionnaires. The questionnaires included five parts, which recorded: (1) General information questionnaire; (2) Chinese version of the Post Traumatic Growth Inventory (PTCI-G); (3) The Chinese translation of the Impact of Event Scale-Revised (CIES-R); (4) The Chinese Trait Coping Style Questionnaire (TCSQ); and (5) Number Rating Scale (NRS). General information questionnaire The general information questionnaire was designed by the researchers which was mainly used to collect demographic information and disease-related information on the participants. The demographic information includes age, gender, Body Mass Index (BMI), education, occupation, economic condition, marital status and religious beliefs. Disease-related information covers tumour type, tumour size, tumour location, type of surgery, length of stay, etc. We collected this data when patients were hospitalized (T1). Chinese version of the Post Traumatic Growth Inventory (PTGI-C) PTGI-C was used to assess the positive outcomes reported by people who have experienced a traumatic event. The original scale was developed by foreign scholars Tedeschi and Calhoun. It was introduced into China in 2008 by Chinese scholars Wang Ji et al. The content of the scale was translated and adapted [ 31 ], and has been validated in patients with bone tumours, with a Cronbach's alpha coefficient of 0.91 and a goodness-of-fit index of 0.90 [ 32 ]. It contained 21 entries divided into five dimensions: relevance to others, new possibilities, personal strength, spiritual change and appreciation of life [ 31 ]. The scale was based on a 6-point Likert scale, with each item ranging from “not at all” to “very much” corresponding to a score of 0 to 5, and a total score of 0 to 100, with higher scores indicating higher levels of PTG [ 31 ]. We collected the PTGI-C in 4 time (T1-T4). The Chinese translation of the Impact of Event Scale-Revised (CIES-R) CIES-R was a widely used self-assessment scale that measures the degree to which an individual was psychologically affected after experiencing a traumatic event[ 33 ]. The original scale was developed by Horowitz et al and it was revised by Weiss and Marmar. We used the revised version was translated in Chinese by Guo Suran et al with the internal consistency and half-score reliability of the scale was > 0.8, and the validity scale correlation validity was 0.55 [ 34 ]. It consisted of 3 sub-dimensions, namely intrusion, avoidance and high arousal, and contains 22 entries [ 34 ]. Scoring was based on a 5-point Likert scale with a total score of 0 to 88. A score of 0 to 8 indicates no clinical symptoms of PTS, 9 to 25 the presence of mild symptoms, 26 to 43 moderate symptoms, and ≥ 44 severe symptoms [ 35 ]. A score > 26 indicates significant PTS symptoms, and a score > 35 can be used as a criterion for diagnosing PTSD [ 34 ]. Patients’ CIES-R scores were collected 3 days before surgery and 2 days after surgery (T1 and T2). In our study, patients were divided into a low (languishing) and high (flourishing) PTS group based on their CIES-R score two days after surgery using a cut-off score of 26 for the analysis of influencing factors. It indicated the influence of surgery mainly when patients just experienced the surgery. The Chinese Trait Coping Style Questionnaire (TCSQ) TCSQ was a questionnaire developed by Chinese scholars to assess the coping style of individuals which was used in this study to assess the type of coping style adopted by patients in response to the surgical event. It was one of the influencing factors of PTG to be explored. When confronted with a stressful event that may act as a stressor (in this study, surgery was the stressful event), individuals tended to adopt different cognitive, emotional or behavioural response strategies, which are defined as coping styles [ 36 ]. Researchers have categorized these coping styles into positive and evasive type [ 36 ]. Both positive and evasive coping are relatively stable coping strategies that existed in individuals and were related to personality traits [ 37 ]. The Cronbach’s α for the positive and evasive coping dimensions were 0.70 and 0.69, respectively, with a calibration correlation validity of 0.60 [ 38 ]. They suggested that the instrument had good reliability and validity. We collected this data when patients were hospitalized (T1). Number Rating Scale (NRS) This scale was the most widely used unidimensional scale. The scale consisted of 11 points from 0–10, representing a score of 0–10. 0 meant no pain at all while10 meant severe pain. The score increased from small to large to indicate progressively increasing pain. Patients chose the value that best matched the pain they felt at that moment, based on how they experienced it. Pain was one of the influencing factors of PTG explored in this study which we collected in both 4 times (T1-T4) Statistics Data were analysed using SPSS software (version 26.0; SPSS Inc., Chicago, IL, USA) and MPLUS 8.4. The statistical description of the measures was done by means ± standard deviation, median and interquartile spacing. Statistical analysis was done by t-test, analysis of covariance, rank sum test and other tests. For categorical data, statistical descriptions such as composition ratios and rates were used, and statistical analyses were performed using chi-square tests and fisher’s exact probability method. We used latent class trajectory models to identify trajectories of PTG over time. This was a specialized form of finite mixture modelling and was designed to identify latent classes of individuals following similar progressions of a determinant over time or with age. Due to the small sample size, the χ 2 test was used to identify possible predictors, and differences were considered statistically significant at P ≤ 0.10 to avoid omission, with the remaining statistical test level α = 0.05. One of the screening methods for logistic regression variables was to first screen variables from a large number of potential independent variables (based on previous studies and our own clinical experience) by designing a more relaxed Type I error rate through univariate statistical analysis[ 39 ].The fit indicators for the Latent Class Growth Model (LCGM) included the Akaike Information Criterion (AIC), Bayesian information criterion (BIC), sample-corrected Bayesian information criterion (aBIC), entropy, LoMendell likelihood ratio test (LMR)likelihood ratio test (LRT) and Bootstrap-based likelihood ratio test (BLRT). The best model was determined by combining practical implications and statistical indicators. Finally, logistic regression was used to analyze the factors influencing PTG in patients with different latent trajectories. Results According to the inclusion and exclusion criteria of this study, a total of 153 study subjects who met the criteria were included. During the follow-up period of 1 month after surgery, a total of 12 patients were lost to follow-up, with a loss rate of 7.8%. The reasons for loss of follow-up were as follows: change of condition within 1 month after surgery, including serious post-operative complications (2 cases) and poor wound healing (1 case). Patients could not be contacted after discharge and did not attend regular outpatient check-ups (4 cases). Refusal to accept follow-up surveys for personal reasons (4 cases). And loss of contact due to sudden natural disasters in the area (1 case). All of them were excluded from the study, and a total of 141 patients were included. General information of participants The demographic data of the 141 study subjects showed that the gender ratio of the patients was 50.4% (male) and 49.6% (female) respectively, with a similar composition, and their age was 33.48±12.47 years. The marital status was only married and unmarried, 83 (58.9%) and 58 (41.1%) cases respectively. The largest proportion of the respondents had a bachelor’s degree or above in education, with 39 cases (27.7%). In terms of disease-related data, tumour site was predominantly lower limb (95 cases, 67.4%) and tumour type was predominantly giant cell tumour of bone (33 cases, 23.4%) and osteosarcoma (29 cases, 20.6%). The study population included 83 cases (58.9%) of benign bone tumours and 58 cases (48.1%) of malignant tumours. As junctional tumours such as giant cell tumour of bone was already able to have distinct benign and malignant features when pathological staging was done, they could be directly classified as benign or malignant bone tumours at the time of analysis, based on the pathological report results. In terms of the type of surgery, the surgery was mainly divided into resection of the tumour segment, supplemented by plate and screw internal fixation, joint fusion, autologous/allogeneic bone graft and tumour joint prosthesis or modular joint prosthesis replacement, with some patients with malignant tumours undergoing additional peri-tumour lymph node dissection, and all patients undergoing soft tissue repair at the surgical site. In this study, 47 patients (33.3%) underwent bone tumour resection plus bone reconstruction and 48 patients (34.0%) also underwent bone tumour resection plus tumour arthroplasty. The average length of stay for patients undergoing bone tumour surgery was 7.67±2.34 days. Additionally, the mean values of PTGI-C at different monitoring time points were 41.24±21.94, 44.56±23.33, and 40.69±22.63, respectively and repeated measures analysis of variance with Univariate showed that the differences of PTGI-C measured at different time points were statistically significant (F=3.372, P=0.02). The general information of the 141 subjects is shown in Table 1. Table 1 General information of bone tumour patients with surgery Trait Category Number Composition Ratio (%) / ` x±s / M(QR 1 ) Gender Male 71 50.4 Female 70 49.6 Age （ y ） 141 33.48±12.47 BMI （ Kg/m 2 ） 141 22.33±3.29 Marital Married 83 58.9 Unmarried 58 41.1 Education Junior high school 31 22.0 High school and secondary school 37 26.2 Junior colleges 34 24.1 Bachelor degree or above 39 27.7 Religion YES 7 5.0 NO 134 95.0 Income Monthly ＜2000 30 21.3 2000~5000 47 33.3 5001~10000 44 31.2 ＞10000 20 14.2 Residence City 82 58.2 County 28 19.9 Countryside 31 22.0 Site of the tumour Upper limbs 40 28.4 Lower limbs 95 67.4 Other 6 4.3 Type Giant cell tumour 33 23.4 Osteosarcoma 29 20.6 Fibrogenic tumours 16 11.3 Other mesenchymal tumours 26 18.4 Cartilage-origin tumour 25 17.7 Other 12 8.5 Histology Benign 83 58.9 Malignant 58 48.1 Surgery type Tumour segment resection 35 24.8 Tumour segment resection and elongated bone reconstruction 47 33.3 Tumour segment resection plus joint replacement 48 34.0 Other 11 7.8 Implants YES 93 66.0 NO 48 34.0 History of surgery YES 87 61.7 NO 54 38.3 Time since diagnosis (month) 142 5 [2, 12] Chemotherapy YES 42 29.8 NO 99 70.2 Sleep quality Very good 5 3.5 Good 50 35.5 General 54 38.3 poor 32 22.7 Sleep duration/per day (hours) ＜5h 31 22.0 5~6h 32 22.7 6~7h 44 31.2 ＞7h 34 24.1 Hospital stay （ days ） 141 7.67±2.34 PTGI-C 2 T1 141 41.24±21.94 T2 141 44.56±23.33 T3 141 40.69± 22.63 T4 141 46.62±22.99 F=3.372, P=0.025 Note: 1 Indicates Interquartile range. 2 PTGI-C: Chinese version of the Post Traumatic Growth Inventory Model Fitting and Selection of PTG Trajectories PTGI-C scores of patients at 4 time points were taken as the observation index with setting the free estimation of time parameters, and 1-5 categories were extracted successively for model fitting analysis. The results show that only 2 types of models have significant LMR, LRT and BLRT values. At the same time, with the increase of the number of classifications, AIC, and aBIC values increased first and then decreased. The BIC increases and Entropy reaches its maximum value (Table 2). Above all, this study applied the 2 LCGM model of categories and combining the characteristics of the trajectory of change in PTGI-C, PTGI-C were divided into 2 subgroups. The results showed that category group 1 had a higher PTGI-C score at the admission (intercept =44.276) and mean of the PTGI-C with an overall increasing trend (slope =5.152 P < 0.001), indicating that the PTG were maintained at a high level. Therefore, category group 1 was named the “increasing trajectory group”. The PTGI-C score at the admission was lower than that of category 1 (intercept = 35.164) and the entire line was below the average, with an overall decreasing trend (slope =−4.718, P < 0.001), so category 2 was named the “decreasing trajectory group”. The potential categories of the trajectory of the change in the PTG of the two groups are shown in Table 3 and Figure 1. The scores of PTGI-C for different periods in each group are shown in Table 4, including 91 cases (64.54%) in the “increasing trajectory group”, and 60 cases (35.46%) in the “decreasing trajectory group”. Table 2 Fitting Results of LCGM Number of Classes AIC BIC saBIC Entropy LMR LRT BLRT 1 4848.167 4874.706 4846.230 - - - 2 4840.262 4875.647 4837.679 0.717 0.0399* 0.0389* 0.0150* 3 4841.256 4885.487 4838.028 0.743 0.6690 0.6849 0.4350 4 4836.849 4889.927 4832.975 0.754 0.3986 0.4119 0.2500 5 4834.656 4896.580 4830.136 0.797 0.2341 0.2624 0.0609 Abbreviations: AIC, Akaike information criterion. BIC, Bayesian information criterion. saBIC, sample size adjusted BIC. LMR, LoMendell likelihood ratio test. LRT, Likelihood Ratio Test. BLRT, bootstrap likelihood ratio test. * indicates P＜0.05. Table 3 Intercept and Slope of Each Class Class Intercept P Slope P Class 1(Increasing trajectory group) 44.276 P＜0.001 5.152 P＜0.001 Class 2(Decreasing trajectory group) 35.164 P＜0.001 -4.718 0.003 Table 4 Univariate Analysis of Patient-Reported Outcome Trajectories Projects Category Increasing trajectory Group (n=91) Decreasing trajectory Group (n=50) c 2 /t P Gender (%) Male 44 (48.4) 27(54.0) 0.41 0.521 Female 47 (51.6) 23(46.0) Age （ year ） ＜27 42(46.2) 13(26.0) 6.27 0.042* 28-39 26(28.6) 23(46.0) ＞40 23(25.2) 14(28.0) BMI （ Kg/m 2 ） 22.16±3.38 22.65±3.13 -0.86 0.390 Marital status (%) Married 47(51.6) 36(72.0) 5.52 0.019* Unmarried 44 (48.4) 14(28.0) Education (%) Junior high school 21(23.1) 10 (20.0) 5.17 0.160 High school and secondary school 22(24.2) 15(30.0) Junior colleges 18(19.8) 16(32.0) Bachelor’s degree or above 30(32.9) 9(18.0) Religion (%) YES 5(5.5) 2(4.0) 0.15 0.196 NO 86(94.5) 48(96.0) Income Monthly (%) ＜2000 17(18.7) 13(26.0) 1.11 0.775 2000~5000 32(35.1) 15(30.0) 5001~10000 29(31.9) 15(30.0) ＞10000 13(14.3) 7(14.0) Residence (%) City 50(54.9) 32(64.0) 1.15 0.563 County 19(20.9) 9(18.0) Countryside 22(24.2) 9(18.0) Site of the tumour (%) Upper limbs 26(28.6) 14(28.0) 2.69 0.261 Lower limbs 63(69.2) 32(64.0) Other 2(2.2) 4(8.0) Type (%) Giant cell tumour 25(27.5) 8(16.0) 10.28 0.064 Osteosarcoma 20(22.0) 9(18.0) Fibrogenic tumour 7(7.7) 9(18.0) Other mesenchymal tumour 17(18.7) 9(18.0) Cartilage-origin tumour 18(19.8) 7(14.0) Other 4(4.3) 8(16.0) Histology (%) Benign 57(62.6) 26(52.0) 1.51 0.219 Malignant 34(37.4) 24(48.0) Surgery type (%) Tumour segment resection 18(19.80 17(34.0) 3.58 0.310 Tumour segment resection and elongated bone reconstruction 32(35.2) 15(30.0) Tumour segment resection plus joint replacement 33(36.3) 15(30.0) Other 8(8.8) 3(6.0) Implants (%) YES 62(68.1) 31(32.0) 0.54 0.462 NO 29(31.9) 19(38.0) History of surgery (%) YES 58(63.7) 29(58.0) 0.45 0.503 NO 33(36.3) 21(42.0) Time since diagnosis (month) 6 [2,12] 5[2.10] 2048.00 b 0.325 Chemotherapy (%) YES 23(25.7) 19(38.0) 2.50 0.114 NO 68(74.7) 31(61.0) Sleep quality (%) Very good 4(4.4) 1(2.0) 1.33 1 0.752 Good 31(34.1) 19(38.0) General 37(40.7) 17(34.0) poor 19(20.9) 13(26.0) Sleep duration/per day (hours) ＜5h 18(19.8) 13(26.0) 2.59 0.460 5~6h 22(24.2) 10(20.0) 6~7h 26(28.6) 18(36.0) ＞7h 25(27.4) 9(18.0) Hospital stay （ days ） 7.67±2.41 7.68±2.22 0.02 0.981 Coping style Positive 24(26.4) 6(12.0) 3.98 0.046* Evasive 67(73.6) 44(88.0) CIES-R 3 T1 14 [7,24] 10 [3,18] 1825.50 2 0.053 T2 27 [9,32] 12.5 [5, 28] 1674.50 b 0.010* PTS 4 High level 48(52.7) 16(32.0) 5.60 0.018* Low level 43(47.3) 34(68.0) Pain level T1 1.91±1.82 2.24±2.28 T2 4.20±2.07 4.64±2.06 T3 2.98±1.99 3.08±1.88 T4 2.35±1.55 2.22±1.43 244.94 6 ＜ 0.001* PTGI-C 5 T1 45.42±20.93 33.21±21.80 T2 50.15±20.26 34.41±25.26 T3 51.73±18.67 19.98±12.69 T4 60.34±13.31 19.78±11.05 100.41 6 ＜ 0.001* Note: * Indicates P＜0.05. 1 Indicates Fisher’s exact probability method. 2 Indicates Mann-Whitney U test method. 3 CIES-R: The Chinese translation of the Impact of Event Scale-Revised. 4 PTS: Post Traumatic Stress. The Cut-off of CIES-R was 26. CIES-R≥26 indicates higher PTS while CIES-R<26 indicates lower status of PTS. 5 PTGI-C: Chinese version of the Post Traumatic Growth Inventory. 6 Indicates results of repeated measures analysis of variance. Univariate analysis and Logistic Regression Analysis of Factors Influencing the Type of PTG The results showed that the two trajectory categories of age, marital status, coping style, CIES-R on post-operative 2 days and Post Traumatic Stress (PTS) were statistically significant (P<0.05) when comparing PTGI-C scores, as shown in Table 4. The variables with statistical significance in the univariate analysis (P＜0.10) were used as independent variables, and the two groups of trajectory categories were used as dependent variables for the Binomial Logistic Regression Analysis. The forward stepwise regression method based on maximum likelihood estimation was used for the analysis. The influencing factors for the decreasing trajectory group relative to the increasing trajectory group were marital status, type of tumour, and PTS (P＜0.05). The results showed that unmarried (OR=0.381, P=0.019), low level of PTS (OR=2.666, P=0.015), Giant cell tumour (OR=0.223, P=0.047), Fibrogenic tumours (OR=0.127, P=0.007), cartilaginous origin tumour (OR=0.194, P=0.034), and other tumours (OR=0.169, P=0.023) were predictive factors for PTG trajectory. The fit of this Binary Logistic regression model was P= 0.947(P＞0.05) in the Hosmer Lemeshow test. The Omnibus test showed that the model was significant in general (P=0.002＜0.05), and the model predictive power of Binomial Logistic Regression fitting equation was 66.0%. The result was shown in table 5. Table 5 Logistic Regression Analysis of Patient Reported Outcome Trajectories Variables B SE Wald c 2 p OR (95%CI) Marital status (Ref =Married) -0.965 0.412 5.481 0.019 0.381[0.170-0.855] Type Giant cell tumour (Ref = Osteosarcoma) -1.503 0.756 3.948 0.047 0.223[0.051, 0.980] Fibrogenic tumour (Ref = Osteosarcoma) -2.063 0.768 7.210 0.007 0.127[0.028,0.573] Other mesenchymal tumour (Ref = Osteosarcoma) -0.684 0.820 0.696 0.404 0.505[0.101,2.517] Cartilage-origin tumour (Ref = Osteosarcoma) -1.640 0.774 4.485 0.034 0.194[0.043,0.885] Other (Ref = Osteosarcoma) -1.778 0.780 5.193 0.023 0.169[0.037,0.780] PTS 1 (Ref = low level) 0.981 0.402 5.953 0.015 2.666[1.213, 5.860] Note: Omnibus Tests of Model Coefficients showed P=0.002＜0.05. Hosmer and Lemeshow showed P=0.947＞0.05. Model predictive power was 66.0%. 1 Indicates Post Traumatic Stress. Discussion To our knowledge, this study was the first one which focused on the trajectories of PTG among bone tumour patients at the early time after surgery. It was also the first study to explore the categories and predictive factors of PTG trajectories when patients finished the surgery or plus other therapy. We found that the patients could be divided into two group basing on the PTG trajectories including increasing group and decreasing group. It was obvious that the patients in increasing group experienced continuous growth of PTG as time goes on while the PTG level of decreasing group patients gradually fell with time. The PTG of patients in the growth group was also consistently higher than the average of all patients. The other group was consistently below average. Interestingly, the age, marital status, coping style, CIES-R on post-operative 2 days, level of PTS, and categories of tumours would predict the tendency of PTG basing on univariate analysis and multivariate analysis. We selected a total of four time points for repeated measurements of PTG, including 3 days before surgery (T1), 2 days after surgery (T2), 15 days after surgery (T3), and 30 days after surgery (T4). Because patients were usually admitted to hospital 3 days before surgery in China, when general information will be collected clearly, which will ensure the completeness and accuracy of the information. The time chosen for follow-up was based on the patient’s post-operative recovery process. They would have their wound stitches removed in the outpatient clinic on 15 days after surgery, at which point the wound would have healed and the HCWs would be available to guide the patient through the full recovery process. In addition, their first post-operative review in the outpatient clinic on 30 days after surgery, which was a time of high incidence of various post-operative complications in bone tumours and was a time when Orthopaedic surgery patients should emphasize. Patients with malignant bone tumours who also required a combination of neoadjuvant chemotherapy postoperatively, then typically begin their first postoperative chemotherapy session 30 days later which may result in new traumatic events [ 40 ]. Therefore, HCWs had more opportunities to contact with patients during this period, for example, psychological support[ 41 ]. Additionally, interests in the experiences of bone tumour patients who just went through the diagnosis and therapy induced us emphasize on the PTG level during 1 month after surgery. A stressful event may be enough to challenge a set of deeply held assumptions about the world and the self. For some, this would lead to PTS, while for others, it might lead to positive psychological changes, a person's response to a challenge was beneficial [ 30 ]. Based on the theoretical model of posttraumatic growth, it can be inferred that in the early stage of traumatic events, individuals need to reconstruct all aspects such as schema and core values to produce PTG, which requires a certain reaction time[ 42 , 43 ], and the length of this time was still inconclusive. Hence, most of the prior research reported the long-term PTG level of patients who had been diagnosed or treated for years or even decades, but few focused on the changes of PTG in patients with tumours undergoing therapeutic surgery for the first time. However, latest studies have shown that PTG occurring in the short term after traumatic events was often more meaningful, which would affect the patient’s long-term PTG level, functional recovery and quality of life [ 44 , 45 ] In this study, the median time to diagnosis of the patients was 5 [2-12] months, and all patients had their first bone tumour treatment surgery. If the patients and risk factors of PTG reduction trajectory could be identified in the early stage of tumour-related traumatic events (including tumour treatment and diagnosis) [ 46 ], it would be effective to the improvement or maintenance of PTG levels in the later stage. Unlike previous studies[ 47 ], we did not only focus on the level of PTG in patients with tumour but also the global change after 1 month with surgery. Based on the assumption of population homogeneity, we further explored the category of potential trajectories of PTG generated by individual heterogeneity. Patients undergoing bone tumour surgery, including those with benign and malignant bone tumours, had two groups of latent classes of PTG trajectories. In a longitudinal study of patients with head and neck cancer, positive psychology increased and then decreased early in diagnosis and treatment [ 47 ]. Fauske et al conducted the qualitative study which showed that patients with bone sarcoma were more likely to have emotional problems [ 15 ]. It was also reported that different categories of PTG change trajectories existed in different tumour population[ 48 ]. However, they both focused on specific group with tumour and did not recognize the heterogeneity of individuals in this population. Through the establishment of latent category trajectory, we were able to more accurately identify the PTG ascending group and decline group. On this basis, precise intervention for high-risk bone tumours with decreased PTG could be targeted. It was particularly important to explore and monitor the predictors of PTG growth trajectory and decline trajectory which also guided us to do further research. After confirming the change trajectory of PTG in different populations, we also identify the predictors or influencing factors of PTG reduction trajectory. Firstly, the unmarried status was a protective factor for the decrease of PTG which was a novel finding. Differently, relevant studies have found that being married was a protective factor for low PTG levels in cancer patients [ 49 ]. The study inferred that married people received more social support than unmarried people which was a mediator of marital status and PTG in Korea. However, this may be related to the gender of the sample included in. Previous studies tended to analyse PTG levels only in men or women, but our study included both male and female patients for analysis[ 49 , 50 ]. Moreover, in the cultural background of China, the family system of married patients has been transformed from a large family system to a small “nuclear family” which cantered on husband and wife [ 31 ]. The family support of unmarried patients often came from all family members, while the family support of married patients was mainly from spouse [ 51 ]. If the level of marital adjustment was too low, it was likely to affect the early PTG level [ 52 ]. Therefore, to maintain a high level of PTG in patients with bone tumours over the long term, HCWs should identify how marital status affects PTG. Whether married or unmarried patients, we should find the risk factors that affect PTG in time, and carry out psychological support to them, such as health education for family members to improve social support and patient’ care skills. In this way, patients could be guaranteed effective social and medical support during treatment, regardless of family structure and marital status. Secondly, the active coping strategies could help patients build up high level of PTG. Our findings were like other research’s outcomes. A cross-sectional study of Asian cancer patients also showed that positive coping style was beneficial for personal growth [ 53 ]. Gori and his colleges also confirmed the relationship between coping style and PTG level [ 54 ]. However, the predictive and practical effects of positive coping styles on the trajectory of PTG change cannot be well interpreted in aforementioned studies. Although many different components were thought to interact in intricate ways to cause post-traumatic development, cognitive processes seem to play a specific role in these interactions [ 55 ].Tumour, on the other hand, was an intensely signifying event that destroys an individual’s sense of self and somatopsychic link, necessitating an introspective concentration, developing awareness, and meaning-making of one's own experience to permit complete elaboration[ 56 ]. Considering prior research and the present study, we might infer that active coping strategies were able to help bone tumour patients actively complete cognitive processing of traumatic events and reconstruct the world assumption through deliberate rumination [ 55 ]. Therefore, identifying bone tumour surgery patients who had evasive coping strategies and teaching them to cope with traumatic events may be beneficial for medical staff to improve PTG. When patients were in a coping-avoidance state, HCWs should teach them ways to cope with the impact of the tumour. For example, it was necessary to inform them about patients who have gotten better with treatment. By hinting at some case outcomes of treatment success, the patient’s confidence in coping would be improved a lot. Thirdly, there were also significant differences in PTG levels among patients with different types of bone tumours. Compared with osteosarcoma, other types of bone tumours were protective factors for PTG reduction. Osteosarcoma, which ranks first among malignant bone-related cancers in adolescents, had complex heterogeneity and abnormally generated immature osteoid matrix[ 57 ]. About 35%-45% of patients with osteosarcoma have chemoresistance and poor response to treatment, and these patients are prone to distant metastasis. The 5-year survival rate of patients with distant metastasis was less than 20% [ 58 ]. Hence, once diagnosed as osteosarcoma, it must bring a heavy blow to the patients and their families. In the early stages of treatment, it was often difficult to maintain a high level of PTG. This suggests that it was necessary for nurses to provide psychological support to patients with malignant tumour. The treatment of bone tumours was complex and lengthy. We cannot avoid the continuous influence of various traumatic events on individuals. Whether it was the diagnosis of tumours, the persistence of treatment, the prognosis, the change of body image, and the change of functional autonomy and/or role, may be repeated throughout the whole life cycle of patients with bone tumours, especially those with malignant bone tumours[ 59 ]. In the context of understanding the dynamic changes of PTG, timely intervention for high-risk groups in time when low levels of PTG are likely to occur was bound to improve the psychological state of patients and the prognosis of the disease. Finally, this study validated the positive correlation between PTS and PTG in patients with bone tumours. PTS was one of the most frequently reported negative psychological phenomena in cancer patients. It mainly included post-traumatic stress disorder (PTSD) and post-traumatic stress symptom (PTSS)[ 60 ]. They were clinical diseases and Sub-syndromic symptoms, respectively [ 44 ]. Previous research evaluating the association between PTS and PTG found varying results in terms of the degree, direction, and linearity of this relationship [ 44 ] Some research, such as [ 61 ], claim a positive association between PTS and PTG, while others, such as [ 62 ], claim a negative relationship. Our findings were in line with the research results of Morrill[ 63 ], Groarke[ 32 ], Chen[ 64 ] and other scholars, and was also the view advocated by most empirical studies at present. Some researcher believed that the positive correlation between the two was due to the fact the more threatening an event was, the more it would promote the alternate occurrence of growth and stress response. Then they would lead to a stronger relationship between the two structures [ 44 , 65 ], resulting in the result of both growths. Although a higher level of psychological impact may cause a higher level of PTG, patients need to bear a certain degree of psychological pain. However, a high PTS rate was maladaptive and can hinder the progression of PTG. An individual with an excessive level of PTS could not have the capacity to reconstruct cognition, such as core beliefs, which may form the basis of PTG[ 65 ]. Understanding the link between PTG and PTS was critical for a better understanding of post-traumatic reactions in cancer patients, but it was also critical to understand how they correlate. As nurses, when evaluating the psychological status of patients, we should include both positive and negative psychological states in the evaluation, which was conducive to accurately evaluate all the psychological states of patients with bone tumours, so as to provide more targeted psychological guidance to them and alleviate some of the pain on the premise of creating conditions conducive to PTG. In the future, we still need to explore the threshold of PTS based on studies showing a positive correlation between PTS and PTG. This will facilitate our subsequent intervention to be more precise and effective. Limitations The study also has several limitations that restrict the findings’ generalizability. Firstly, due to the low incidence and prevalence of bone tumours, only 141 patients with bone tumour surgery were included in this study in one hospital, China. The follow-up time was only one month. In the future, large sample, multi-centre and continuous follow-up participants are still needed to demonstrate the trajectory of PTG and its influencing factors. Second, although the heterogeneity of the sample leads to a reduction in selection bias from the perspective of different bone tumour types, it may also lead to a reduction in internal validity. Although there was no difference between benign and malignant tumours in univariate analysis. However, future studies may consider adopting more complex statistical analysis methods to improve internal validity. Also, it is necessary to consider that other factors may play a role in the development of cancer-related posttraumatic reactions (other personality factors, other life events, perception of stress, etc.), which were not examined in this study. It is worth further investigation in future studies. Conclusion Our study was a 1-month longitudinal study of patients undergoing bone tumour surgery. Based on the concept of individual heterogeneity, the LCGM was used to confirm the change trend of PTG level in patients with bone tumour surgery into an increased group and a decreased group. Marital status, coping style, tumour type and level of PTS were the influencing factors of PTG decreasing trend group through univariate analysis and logistic regression. This provides empirical and theoretical evidence for the study of positive psychology and mental wellbeing in patients with tumour. It also laid the foundation for HCWs to develop interventions to improve positive psychological outcomes. Declarations Ethics approval and consent to participate: Ethical considerations were upheld throughout the study, adhering to the principles outlined in the Declaration of Helsinki. The study received approval from the West China Hospital Ethics Committee and all participants provided informed consent by signing consent forms. Consent for publication: Authors, institutions and participants have consent of publication. All authors have reviewed the manuscript before submission. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Funding Declaration: Not applicable. Competing interests: There are no conflicts declared. Funding: Not applicable. Authors’ contributions: YL designed the research, collected and analysed the data of bone tumour patients, and drafted this manuscript. XFZ collected and analysed the data of bone tumour patients. PFL modified the research design and assisted investigating of data among bone tumour patients and revised the manuscript. YTW and JW revised the statistic model of analysing trend of post traumatic growth among bone tumour surgery patients. CQT and HD defined the criteria for participants of the study and supported the idea of methodology of this research. JLC and NN came up with the idea of the research, supervised the process of research and revised the manuscript. Acknowledgements: We are grateful to Professor Richard G. Tedeschi for permission to use the Posttraumatic Growth Inventory (PTGI). References Niu X, Xu H-R, Inwards CY, et al. Primary Bone Tumors: Epidemiologic Comparison of 9200 Patients Treated at Beijing Ji Shui Tan Hospital, Beijing, China, With 10 165 Patients at Mayo Clinic, Rochester, Minnesota. Archives Pathol Lab Med. 2015;139 9:1149–55. https://doi.org/10.5858/arpa.2014-0432-OA . Scotlandi K, Hattinger CM, Pellegrini E, Gambarotti M, Serra M. Genomics and Therapeutic Vulnerabilities of Primary Bone Tumors, Cells 9, no. 4 (2020): 968. https://doi.org/10.3390/cells9040968 Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022, CA: A Cancer . J Clin. 2022;72(1):7–33. https://doi.org/10.3322/caac.21708 . Gill J, Gorlick R. Advancing therapy for osteosarcoma. Nat Reviews Clin Oncol. 2021;18(10):609–24. https://doi.org/10.1038/s41571-021-00519-8 . Marec-Berard P, Laurence V, Occean B-V, et al. Methotrexate–Etoposide–Ifosfamide Compared with Doxorubicin–Cisplatin–Ifosfamide Chemotherapy in Osteosarcoma Treatment, Patients Aged 18–25 Years. J Adolesc Young Adult Oncol. 2020;9(2):172–82. https://doi.org/10.1089/jayao.2019.0085 . Yu Z, Zhang W, Fang X, Tu C, Duan H. Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I + IV Resection. Front Oncol. 2021;11:629582. https://doi.org/10.3389/fonc.2021.629582 . Shoaib Z, Fan TM, Irudayaraj JMK. Osteosarcoma mechanobiology and therapeutic targets. Br J Pharmacol. 2021;179(2):201–17. https://doi.org/10.1111/bph.15713 . El Ghoneimy AM, Shehab AM, Farid N. What is the Cumulative Incidence of Revision Surgery and What Are the Complications Associated With Stemmed Cementless Nonextendable Endoprostheses in Patients 18 Years or Younger With Primary Bone Sarcomas About the Knee. Clin Orthop Relat Res. 2022;480(7):1329–38. https://doi.org/10.1097/CORR.0000000000002150 . Severyns M, Briand S, Waast D, Touchais S, Hamel A, Gouin F. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis: Incidence, characterization and functional impact, Surgical Oncology 26, no. 2 (2017): 171–177. https://doi.org/10.1016/j.suronc.2017.03.005 Ciechanowicz D, Kotrych D, Dąbrowski F, Mazurek T. Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons. J Clin Med. 2022;11:15. 4284, https://doi.org/10.3390/jcm11154284 . Biermann JS, Chow W, Reed DR, et al. NCCN Guidelines Insights: Bone Cancer, Version 2.2017. J Natl Compr Canc Netw. 2017;15(2):155–67. https://doi.org/10.6004/jnccn.2017.0017 . Li ZH, Pan Z, Guo H, Fei X, Cheng DD. Yang Long-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors . J Clin Med. 2022;11:7225. 10.3390/jcm11237225 . Liu C, Min L, Zhou Y, et al. Long-term results of uncemented allograft prosthesis composite reconstruction for the tumor in proximal femur: a minimum follow-up of sixty-five months. BMC Musculoskelet Disord. 2021;22(1):128. https://doi.org/10.1186/s12891-021-03991-6 . Taylor MF, Pooley JA. Sarcoma survivors' perspectives on their body image and functional quality of life post-resection/limb salvage surgery. Eur J Cancer Care. 2017;26(6):e12667. https://doi.org/10.1111/ecc.12667 . Fauske L, Bondevik H, Ahlberg K, Bjørndal A. Identifying bone sarcoma survivors facing psychosocial challenges. A study of trajectories following treatment. Eur J Cancer Care. 2019;28(5):e13119. https://doi.org/10.1111/ecc.13119 . Luzzati F, Giusti EM, Scotto GM, et al. Quality of life, pain, and psychological factors in patients undergoing surgery for primary tumors of the spine. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2020;28(3):1385–93. https://doi.org/10.1007/s00520-019-04965-0 . Yenmez NN, Lyons KS. Perceived Body Image and Perceived Control Are Associated With Physical and Mental Health in Individuals With Cancer. Oncol Nurs Forum. 2022;50(1):19–23. https://doi.org/10.1188/23.ONF.19-23 . Walczak BE, Irwin RB. Sarcoma Chemotherapy. J Am Acad Orthop Surg. 2013;21(8):480–91. https://doi.org/10.5435/JAAOS-21-08-480 . D'adamo DR. Appraising the Current Role of Chemotherapy for the Treatment of Sarcoma. Semin Oncol. 2011;38. https://doi.org/10.1053/j.seminoncol.2011.09.004 . S19-S29. Harrison DJ, Schwartz CL. Osteogenic Sarcoma: Systemic Chemotherapy Options for Localized Disease. Curr Treat Options Oncol. 2017;18(4):24. https://doi.org/10.1007/s11864-017-0464-2 . Ranft A, Seidel C, Hoffmann C, et al. Quality of Survivorship in a Rare Disease: Clinicofunctional Outcome and Physical Activity in an Observational Cohort Study of 618 Long-Term Survivors of Ewing Sarcoma. J Clin Oncol. 2017;35(15):1704–12. https://doi.org/10.1200/JCO.2016.70.6226 . Delgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E. Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2009;17(5):573–9. https://doi.org/10.1007/s00520-008-0529-7 . Das S, Roy RN, Das DK, Chakraborty A, Mondal R. Sleep Quality and its various correlates: A community-based study among geriatric population in a community development block of Purba Bardhaman district, West Bengal. J family Med Prim care. 2020;9(3):1510–6. https://doi.org/10.4103/jfmpc.jfmpc_1021_19 . Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455–71. https://doi.org/10.1007/bf02103658 . Seligman ME, Csikszentmihalyi M. Positive psychology. An introduction. Am Psychol. 2000;55(1):5–14. https://doi.org/10.1037//0003-066x.55.1.5 . Aderhold C, Morawa E, Paslakis G, Erim Y. Protective factors of depressive symptoms in adult cancer patients: The role of sense of coherence and posttraumatic growth in different time spans since diagnosis. J Psychosoc Oncol. 2019;37(5):616–35. https://doi.org/10.1080/07347332.2019.1631931 . Onu DU, Ugwu D, Orjiakor CT. Events Centrality Moderates the Relationship Between Posttraumatic Growth and Health-Related Quality of Life Among People Living With HIV. J Assoc Nurses AIDS Care. 2019;30(6):668–74. https://doi.org/10.1097/jnc.0000000000000094 . Karagiorgou O, Evans JJ, Cullen B. Post-traumatic growth in adult survivors of brain injury: a qualitative study of participants completing a pilot trial of brief positive psychotherapy. Disabil Rehabil. 2018;40(6):655–9. https://doi.org/10.1080/09638288.2016.1274337 . Lindstrom CM, Cann A, Calhoun LG, Tedeschi RG. The relationship of core belief challenge, rumination, disclosure, and sociocultural elements to posttraumatic growth. Psychol Trauma: Theory Res Pract Policy. 2013;5(1):50–5. https://doi.org/10.1037/a0022030 . Tedeschi RG, Calhoun LG. Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychol Inq. 2004;15(1):1–18. https://doi.org/http://www.jstor.org/stable/20447194 . Wang J, Chen H, Wang YB, Liu XH. Revision and reliability and validity analysis of post-traumatic growth assessment scale. J Nurs Sci. 2011;7(14):26–8. Groarke A, Curtis R, Groarke JM, Hogan MJ, Gibbons A, Kerin M. Post-traumatic growth in breast cancer: how and when do distress and stress contribute? Psycho-oncology 26, no. 7 (2017): 967–974. https://doi.org/10.1002/pon.4243 Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress, Psychosomatic medicine 41, no. 3 (1979): 209–218. https://doi.org/10.1097/00006842-197905000-00004 Guo S, Xin ZQ, Geng LN. Reliability and validity analysis of the revised version of the Event Impact Scale. Chin J Clin Psychol. 2007;15(1):15–7. Ye Y, Yang K, Fu J. The impact of bereavement on the bereavement and analysis of related factors. Chin J Gen Practitioners. 2018;21(29):3611–5. Papava I, Oancea C, Enatescu VR, et al. The impact of coping on the somatic and mental status of patients with COPD: a cross-sectional study. Int J Chronic Obstr Pulm Dis. 2016;11:1343–51. https://doi.org/10.2147/copd.S106765 . Ding Y, Yang Y, Yang X et al. The Mediating Role of Coping Style in the Relationship between Psychological Capital and Burnout among Chinese Nurses, PloS one 10, no. 4 (2015): e0122128. https://doi.org/10.1371/journal.pone.0122128 Zhu W, Wei Y, Meng X, Li J. The mediation effects of coping style on the relationship between social support and anxiety in Chinese medical staff during COVID-19. BMC Health Serv Res. 2020;20(1):1007. https://doi.org/10.1186/s12913-020-05871-6 . Stoltzfus JC. Logistic regression: a brief primer. Acad Emerg Med. 2011;18(10):1099–104. https://doi.org/10.1111/j.1553-2712.2011.01185.x . Gong T, Luo Y, Lu M, et al. The optimal strategy for 3D-printed uncemented endoprosthesis for the bone defect reconstruction of the distal radius, based on biomechanical analysis and retrospective cohort study. J Surg Oncol. 2023;127(6):1043–53. https://doi.org/10.1002/jso.27215 . Wu F, Fang X, Yuan D, et al. Preserving the rectus femoris and improving limb function after total femoral prosthesis replacement following resection of femoral malignant tumors. Front Oncol. 2023;13:1149342. https://doi.org/10.3389/fonc.2023.1149342 . Shand LK, Cowlishaw S, Brooker JE, Burney S, Ricciardelli LA. Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis, Psycho-oncology 24, no. 6 (2015): 624–634. https://doi.org/10.1002/pon.3719 Stish BJ, Ahmed SK, Rose PS, Arndt CA, Laack NN. Patient-Reported Functional and Quality of Life Outcomes in a Large Cohort of Long-Term Survivors of Ewing Sarcoma. Pediatr Blood Cancer. 2015;62(12):2189–96. https://doi.org/10.1002/pbc.25710 . Marziliano A, Tuman M, Moyer A. The relationship between post-traumatic stress and post-traumatic growth in cancer patients and survivors: A systematic review and meta-analysis, Psycho-oncology 29, no. 4 (2020): 604–616. https://doi.org/10.1002/pon.5314 Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: A systematic review and meta-analysis, Psycho-oncology 27, no. 4 (2018): 1100–1109. https://doi.org/10.1002/pon.4577 Andrykowski MA, Steffens RF, Bush HM, Tucker TC. Lung Cancer Diagnosis and Treatment as a Traumatic Stressor in DSM-IV and DSM-5: Prevalence and Relationship to Mental Health Outcomes. J Trauma Stress. 2015;28(3):206–13. https://doi.org/10.1002/jts.22005 . Harding SA. The trajectory of positive psychological change in a head and neck cancer population. Int J Oral Maxillofacial Surg. 2018;47(5):578–84. https://doi.org/10.1016/j.ijom.2017.09.010 . Menger F, Mohammed Halim NA, Rimmer B, Sharp L. Post-traumatic growth after cancer: a scoping review of qualitative research. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2021;29(11):7013–27. https://doi.org/10.1007/s00520-021-06253-2 . Kim Y, Kim Y, Kwak Y. Factors associated with post-traumatic growth in male patients with rectal cancer: A cross-sectional study. Eur J Oncol Nurs. 2021;54:102028. https://doi.org/10.1016/j.ejon.2021.102028 . Cui C, Wang K, An J, Jin C. Current status and influencing factors of post-traumatic growth in maintenance hemodialysis. Int J Nurs Sci. 2017;4(4):362–6. https://doi.org/10.1016/j.ijnss.2017.09.008 . Xu HZ, Wang TF, Contract M. Family Wealth Accumulation and Subjective Class Identity Formation: An Empirical Study Based on Chinese Family Tracking Survey data, Journal of Sun Yat-sen University (Social Science Edition) 63, no. 3 (2023): 137–151. https://doi.org/10.13471/j.cnki.jsysusse.2023.03.015 Suo R, Ye F, Xie M, et al. The relationship of marital adjustment and posttraumatic growth in female breast cancer patients and their husbands. Psychol Health Med. 2023;28(2):401–7. https://doi.org/10.1080/13548506.2022.2067339 . Fujimoto T, Okamura H. The influence of coping types on post-traumatic growth in patients with primary breast cancer. Jpn J Clin Oncol. 2021;51(1):85–91. https://doi.org/10.1093/jjco/hyaa159 . Gori A, Topino E, Sette A, Cramer H. Pathways to post-traumatic growth in cancer patients: moderated mediation and single mediation analyses with resilience, personality, and coping strategies. J Affect Disord. 2021;279:692–700. https://doi.org/10.1016/j.jad.2020.10.044 . Szcześniak M, Madej D, Bielecka G. Relationship between World Assumptions and Post-Traumatic Growth among Polish Cancer Patients: Moderating Effect of Rumination. Int J Environ Res Public Health. 2022;19(19):12444. https://doi.org/10.3390/ijerph191912444 . Walsh DMJ, Groarke AM, Morrison TG, Durkan G, Rogers E, Sullivan FJ. Measuring a new facet of post traumatic growth: Development of a scale of physical post traumatic growth in men with prostate cancer. PLoS ONE. 2018;13(4):e0195992. https://doi.org/10.1371/journal.pone.0195992 . Li HB, Huang G, Tu J et al. METTL14-mediated epitranscriptome modification of MN1 mRNA promote tumorigenicity and all-trans-retinoic acid resistance in osteosarcoma, EBioMedicine 82, no. (2022): 104142. https://doi.org/10.1016/j.ebiom.2022.104142 Zhao X, Wu Q, Gong X, Liu J, Ma Y. Osteosarcoma: a review of current and future therapeutic approaches. Biomed Eng Online. 2021;20(1):24. https://doi.org/10.1186/s12938-021-00860-0 . Tang ST, Lin KC, Chen JS, Chang WC, Hsieh CH, Chou WC. Threatened with death but growing: changes in and determinants of posttraumatic growth over the dying process for Taiwanese terminally ill cancer patients, Psycho-oncology 24, no. 2 (2015): 147–154. https://doi.org/10.1002/pon.3616 Jim HS, Jacobsen PB. Posttraumatic stress and posttraumatic growth in cancer survivorship: a review. Cancer J. 2008;14(6):414–9. https://doi.org/10.1097/PPO.0b013e31818d8963 . Dougall AL, Swanson J, Kyutoku Y, Belani CP, Baum A. Posttraumatic Symptoms, Quality of Life, and Survival among Lung Cancer Patients. J Appl Biobehavioral Res. 2017;22(3):e12065. https://doi.org/10.1111/jabr.12065 . Arpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA. Post-traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors, Psycho-oncology 22, no. 10 (2013): 2235–2244. https://doi.org/10.1002/pon.3286 Morrill EF, Brewer NT, O'neill SC et al. The interaction of post-traumatic growth and post-traumatic stress symptoms in predicting depressive symptoms and quality of life, Psycho-oncology 17, no. 9 (2008): 948–953. https://doi.org/10.1002/pon.1313 Chen HM, Chen VC, Hsiao HP, et al. Correlations And Correlates Of Post-Traumatic Growth And Post-Traumatic Stress Symptoms In Patients With Breast Cancer. Neuropsychiatr Dis Treat. 2019;15:3051–60. https://doi.org/10.2147/ndt.S218450 . Baník G, Dědová M, Vargová L. Cancer-related posttraumatic growth and posttraumatic stress: how are they connected and what are their correlates? Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2022;30(10):8183–92. https://doi.org/10.1007/s00520-022-07252-7 . Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Xiaofeng","middleName":"","lastName":"Zheng","suffix":""},{"id":511625459,"identity":"27e7228c-8280-4021-9ad3-a19c7a44198f","order_by":2,"name":"Peifang Li","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Peifang","middleName":"","lastName":"Li","suffix":""},{"id":511625460,"identity":"e084d931-7184-496f-91fe-7ad9a84946ad","order_by":3,"name":"Yitian Wang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Yitian","middleName":"","lastName":"Wang","suffix":""},{"id":511625461,"identity":"98693c41-1f90-400c-bba8-8b7a7364f480","order_by":4,"name":"Jie Wang","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jie","middleName":"","lastName":"Wang","suffix":""},{"id":511625462,"identity":"8e217dad-b881-4833-9dc2-23b80721d4f2","order_by":5,"name":"Chongqi Tu","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Chongqi","middleName":"","lastName":"Tu","suffix":""},{"id":511625463,"identity":"100d9c89-db25-4210-b7d8-5591275fc20d","order_by":6,"name":"Hong Duan","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Hong","middleName":"","lastName":"Duan","suffix":""},{"id":511625464,"identity":"ce919e17-f77d-4834-91ff-7c6121dedb84","order_by":7,"name":"Jiali Chen","email":"","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Jiali","middleName":"","lastName":"Chen","suffix":""},{"id":511625465,"identity":"01389d4a-7773-4e30-a22d-437be386de18","order_by":8,"name":"Ning Ning","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIie2RMQrCQBBFJywkzRpbQy4xEkgUQ7yKEtjKIkeIWNh4gBwjna06mCpgayEoBGy0CNhYWLg2lsmWgvuKDwv/MTsMgEbzi7BPIEAXtsu6xjBSV5w5FUaWiFh9Gi4KwXi9M9K2ZmB16JYkpyg3S78KccPAon3epAwXthhleI3XvAy8GZ5s4EIcG/9D3Pc4UjzMSnRneGXQ476aguc7ugMkI1VQvEoqEW4K4YKi4jOpTJyUqL9CEZutuxxK78FfNJannF+erzDqWlQ0KhKzJ2Oafp8t9Q+sljFWKGo0Gs2/8gZ/UUz1xadK2wAAAABJRU5ErkJggg==","orcid":"","institution":"West China Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Ning","middleName":"","lastName":"Ning","suffix":""}],"badges":[],"createdAt":"2025-07-09 13:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7084287/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7084287/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":91070979,"identity":"14ba71b2-3cc0-4ba3-a13a-fc27c1186d9d","added_by":"auto","created_at":"2025-09-11 10:47:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12815,"visible":true,"origin":"","legend":"\u003cp\u003ePotential categories of PTGI-C trajectory\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7084287/v1/c7902d5707d33bcb9e88e3e2.png"},{"id":91074544,"identity":"752a7db5-23da-4324-b64f-6544b3a96cf2","added_by":"auto","created_at":"2025-09-11 11:03:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1839263,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7084287/v1/bad310a8-6dd1-45b8-8881-3233b1ed0679.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"What are the predominant factors predicting downtrend post-traumatic growth for patients after bone tumour surgery?","fulltext":[{"header":"Background","content":"\u003cp\u003eBone tumours, which encompass diverse mesenchymal tumours originating from bone, cartilage, and connective tissues, represent a highly heterogeneous group ranging from indolent to aggressive and metastatic [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These tumours were relatively rare, accounting for 2% of all human neoplasms. According to the 2022 Cancer Statistics report, there were an estimated 3,910 new cases of bone and joint cancers in the United States, resulting in 2,100 deaths [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Notably, advancements in treatment have placed the management of this disease on the brink of progress, leading to improved survival outcomes for patients with bone tumours [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The 5-year overall survival rate for individuals with malignant bone tumours has significantly increased, with current rates ranging from 65\u0026ndash;70%, a substantial improvement from the previous rate of 20% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSurgery was a crucial component of treatment for nearly all bone tumour patients, involving limb salvage and reconstruction techniques utilizing modular tumour endoprostheses [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In cases where the disease progresses following primary treatment, the panel recommends considering radiotherapy and/or primary site surgery to address local control or provide palliative care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, surgery itself was a traumatic procedure, characterized by a sizable incision and associated risks of complications (approximately 15.4%~27.27%), such as periprosthetic joint infection, periprosthetic bone fracture, and wound infection [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, patients underwent long-term rehabilitation exercises following surgery [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Some of them would experience the impaired body image, perceived control, and self-esteem problems after surgery [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In particular, patients with malignant bone tumours such as osteosarcoma often experience severe physical and mental burden when facing the dramatic changes in body image caused by amputation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] They often adopt avoidant coping strategies and tend to be socially isolated [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMalignant bone tumour patients often underwent chemotherapy/radiotherapy following surgery, which frequently led to adverse reactions like nausea, vomiting, and bone marrow suppression [\u003cspan additionalcitationids=\"CR19 CR20\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. These side effects, especially from chemotherapy significantly impacted patient comfort and gave rise to a range of psychological problems, thereby diminishing quality of life and impeding the recovery process [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A great number of patients with cancer were prone to experiencing psychological disturbances with high prevalence rates during the treatment. Fauske et al conducted a longitudinal study of 18 survivors with bone tumours found that only three participants felt they returned to a life similar to that before their illness, while 15 believed that their lives and bodies had undergone significant changes, with five falling into both psychological and physiological distress, experiencing decreased physical comfort and increased pain[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Luzzati et al. investigated the psychological status of 149 postoperative spinal tumour patients, and found that 49 participants had depressive symptoms (constituting 32.9%), among which 24 (constituting about 49.0%) were mildly depressed, six (constituting about 12.5%) were moderately depressed, and 18 (constituting about 37.5%) were severely depressed [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Negative emotions can affect the patient\u0026rsquo;s recovery process, and there was a possibility of inducing certain adverse reactions or complications which would impair quality of life [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAfter experiencing a series of medical interventions such as diagnosis and treatment, patients not only experience negative psychological states, including the mental health problems but also positive changes or growth, such as mental wellbeing [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Positive psychology was a science that focused on human virtues, strengths, and other positive qualities, and studies positive emotional experiences, cognitive processes, personality traits, creativity, talent development, and other related topics [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Post-traumatic growth (PTG) was a part of positive psychology. It referred to the collection of psychological positive changes experienced by individuals after struggling with traumatic events or situations, first proposed by American scholars Tedeschi and Calhoun in 1996 [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The factors related to PTG mainly focused on demographic characteristics, personality traits, coping strategies, and others [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. At the same time, research has also found that individual positive psychology, such as PTG, were supposed to improve their post-traumatic status and promote positive changes in both physical and mental health [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The population of cancer patients who experienced PTG had a better prognosis, with significantly higher quality of life and disease recovery compared to those who did not experience PTG [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAt present, the research on the psychological status of patients with bone tumour mainly focuses on the incidence of mental health problems, such as anxiety and depression, and the influencing factors of each negative psychological state [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. At the same time, the relationship between psychological status and rehabilitation was also reported, but it did not focus on the psychological status and positive changes in the short term after surgery [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].Therefore, from the perspective of positive psychology, this study took the functional description model of post-traumatic growth as the theoretical basis for in-depth exploration which was analysed from four dimensions: demographic characteristics of patients, the impact of surgery on individuals, individual coping traits and somatic symptoms (pain) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Considering the heterogeneity of the bone tumour patient population, the latent class growth model was used to analyse the level and change trajectory categories of post-traumatic growth of different patients after surgery. The predictors of different trajectory categories were also explored by multilevel models. This study planned to show the level of mental wellbeing of bone tumour patients after surgery and guide healthcare workers (HCWs) to identify bone tumour patients with low level of PTG and its predictive factors and carry out targeted and timely intervention.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and participants\u003c/h2\u003e\u003cp\u003eOur study employed a longitudinal observational design. Participants were bone tumour patients attending the orthopaedics medicine outpatient clinic at a tertiary care hospital. The subjects were selected using convenience sampling. Follow-up examinations, including telephone or WeChat interviews, as well as physical examinations at the Outpatients Department, were conducted every two weeks. Data were collected at four time points: three days before surgery (T1), two days after surgery (T2), 15 days after surgery (T3), and 30 days after surgery (T4). The total follow-up period lasted one month.\u003c/p\u003e\u003cp\u003eThe study included participants who were diagnosed with primary bone tumours and underwent tumour resection between December 2019 and December 2020.\u003c/p\u003e\u003cp\u003eInclusion criteria required participants to have clear consciousness and no communication impairment. Patients were asked for basic information before giving out questionnaires. Patients were conscious if they answered truth-fully and accurately their personal information. Exclusion criteria were as follows: (1) mental illness or cognitive impairment that hindered cooperation with the research, and (2) concurrent heart, liver, renal insufficiency, or other malignant diseases. During the follow-up period, participants were excluded if they underwent re-operation due to disease deterioration, were influenced by other major stress events, withdrew from the study prematurely, or had more than 20% data loss.\u003c/p\u003e\u003cp\u003eThe main outcome measure in this study was a continuous variable, for which the sample size was calculated using the following formula.\u003c/p\u003e\u003cp\u003en = [(Z\u003csub\u003eα/2\u003c/sub\u003e + Z\u003csub\u003eβ\u003c/sub\u003e) * σ / Δ] \u0026sup2;\u003c/p\u003e\u003cp\u003eZ\u003csub\u003eα/2\u003c/sub\u003e was set at 1.96, and Z\u003csub\u003eβ\u003c/sub\u003e was set at 1.28. Based on preliminary pilot testing, the estimated value for σ was determined to be 10, while Δ was set at 3. The sample size was then computed using PASS15.0 software, resulting in a required sample size of 117 participants. Accounting for an anticipated attrition rate of 20%, the sample was expanded to 146 participants.\u003c/p\u003e\u003cp\u003eEthical considerations were upheld throughout the study, adhering to the principles outlined in the Declaration of Helsinki. The study received approval from the West China Hospital Ethics Committee and all participants provided informed consent by signing consent forms. This study has been registered on \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.clinicaltrials.gov/\u003c/span\u003e\u003cspan address=\"https://www.clinicaltrials.gov/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. with the number of ChiCTR2300074170 (Date: 1st August 2023).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMeasurement\u003c/h3\u003e\n\u003cp\u003ePatients were asked to fill out several questionnaires. The questionnaires included five parts, which recorded: (1) General information questionnaire; (2) Chinese version of the Post Traumatic Growth Inventory (PTCI-G); (3) The Chinese translation of the Impact of Event Scale-Revised (CIES-R); (4) The Chinese Trait Coping Style Questionnaire (TCSQ); and (5) Number Rating Scale (NRS).\u003c/p\u003e\n\u003ch3\u003eGeneral information questionnaire\u003c/h3\u003e\n\u003cp\u003eThe general information questionnaire was designed by the researchers which was mainly used to collect demographic information and disease-related information on the participants. The demographic information includes age, gender, Body Mass Index (BMI), education, occupation, economic condition, marital status and religious beliefs. Disease-related information covers tumour type, tumour size, tumour location, type of surgery, length of stay, etc. We collected this data when patients were hospitalized (T1).\u003c/p\u003e\n\u003ch3\u003eChinese version of the Post Traumatic Growth Inventory (PTGI-C)\u003c/h3\u003e\n\u003cp\u003ePTGI-C was used to assess the positive outcomes reported by people who have experienced a traumatic event. The original scale was developed by foreign scholars Tedeschi and Calhoun. It was introduced into China in 2008 by Chinese scholars Wang Ji et al. The content of the scale was translated and adapted [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and has been validated in patients with bone tumours, with a Cronbach's alpha coefficient of 0.91 and a goodness-of-fit index of 0.90 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. It contained 21 entries divided into five dimensions: relevance to others, new possibilities, personal strength, spiritual change and appreciation of life [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The scale was based on a 6-point Likert scale, with each item ranging from \u0026ldquo;not at all\u0026rdquo; to \u0026ldquo;very much\u0026rdquo; corresponding to a score of 0 to 5, and a total score of 0 to 100, with higher scores indicating higher levels of PTG [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. We collected the PTGI-C in 4 time (T1-T4).\u003c/p\u003e\n\u003ch3\u003eThe Chinese translation of the Impact of Event Scale-Revised (CIES-R)\u003c/h3\u003e\n\u003cp\u003eCIES-R was a widely used self-assessment scale that measures the degree to which an individual was psychologically affected after experiencing a traumatic event[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The original scale was developed by Horowitz et al and it was revised by Weiss and Marmar. We used the revised version was translated in Chinese by Guo Suran et al with the internal consistency and half-score reliability of the scale was \u0026gt;\u0026thinsp;0.8, and the validity scale correlation validity was 0.55 [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It consisted of 3 sub-dimensions, namely intrusion, avoidance and high arousal, and contains 22 entries [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Scoring was based on a 5-point Likert scale with a total score of 0 to 88. A score of 0 to 8 indicates no clinical symptoms of PTS, 9 to 25 the presence of mild symptoms, 26 to 43 moderate symptoms, and \u0026ge;\u0026thinsp;44 severe symptoms [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. A score\u0026thinsp;\u0026gt;\u0026thinsp;26 indicates significant PTS symptoms, and a score\u0026thinsp;\u0026gt;\u0026thinsp;35 can be used as a criterion for diagnosing PTSD [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Patients\u0026rsquo; CIES-R scores were collected 3 days before surgery and 2 days after surgery (T1 and T2). In our study, patients were divided into a low (languishing) and high (flourishing) PTS group based on their CIES-R score two days after surgery using a cut-off score of 26 for the analysis of influencing factors. It indicated the influence of surgery mainly when patients just experienced the surgery.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eThe Chinese Trait Coping Style Questionnaire (TCSQ)\u003c/h2\u003e\u003cp\u003eTCSQ was a questionnaire developed by Chinese scholars to assess the coping style of individuals which was used in this study to assess the type of coping style adopted by patients in response to the surgical event. It was one of the influencing factors of PTG to be explored. When confronted with a stressful event that may act as a stressor (in this study, surgery was the stressful event), individuals tended to adopt different cognitive, emotional or behavioural response strategies, which are defined as coping styles [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Researchers have categorized these coping styles into positive and evasive type [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Both positive and evasive coping are relatively stable coping strategies that existed in individuals and were related to personality traits [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The Cronbach\u0026rsquo;s α for the positive and evasive coping dimensions were 0.70 and 0.69, respectively, with a calibration correlation validity of 0.60 [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. They suggested that the instrument had good reliability and validity. We collected this data when patients were hospitalized (T1).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eNumber Rating Scale (NRS)\u003c/h3\u003e\n\u003cp\u003eThis scale was the most widely used unidimensional scale. The scale consisted of 11 points from 0\u0026ndash;10, representing a score of 0\u0026ndash;10. 0 meant no pain at all while10 meant severe pain. The score increased from small to large to indicate progressively increasing pain. Patients chose the value that best matched the pain they felt at that moment, based on how they experienced it. Pain was one of the influencing factors of PTG explored in this study which we collected in both 4 times (T1-T4)\u003c/p\u003e\n\u003ch3\u003eStatistics\u003c/h3\u003e\n\u003cp\u003eData were analysed using SPSS software (version 26.0; SPSS Inc., Chicago, IL, USA) and MPLUS 8.4. The statistical description of the measures was done by means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, median and interquartile spacing. Statistical analysis was done by t-test, analysis of covariance, rank sum test and other tests. For categorical data, statistical descriptions such as composition ratios and rates were used, and statistical analyses were performed using chi-square tests and fisher\u0026rsquo;s exact probability method. We used latent class trajectory models to identify trajectories of PTG over time. This was a specialized form of finite mixture modelling and was designed to identify latent classes of individuals following similar progressions of a determinant over time or with age. Due to the small sample size, the \u003cb\u003eχ\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e test was used to identify possible predictors, and differences were considered statistically significant at P\u0026thinsp;\u0026le;\u0026thinsp;0.10 to avoid omission, with the remaining statistical test level α\u0026thinsp;=\u0026thinsp;0.05. One of the screening methods for logistic regression variables was to first screen variables from a large number of potential independent variables (based on previous studies and our own clinical experience) by designing a more relaxed Type I error rate through univariate statistical analysis[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].The fit indicators for the Latent Class Growth Model (LCGM) included the Akaike Information Criterion (AIC), Bayesian information criterion (BIC), sample-corrected Bayesian information criterion (aBIC), entropy, LoMendell likelihood ratio test (LMR)likelihood ratio test (LRT) and Bootstrap-based likelihood ratio test (BLRT). The best model was determined by combining practical implications and statistical indicators. Finally, logistic regression was used to analyze the factors influencing PTG in patients with different latent trajectories.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAccording to the inclusion and exclusion criteria of this study, a total of 153 study subjects who met the criteria were included. During the follow-up period of 1 month after surgery, a total of 12 patients were lost to follow-up, with a loss rate of 7.8%. The reasons for loss of follow-up were as follows: change of condition within 1 month after surgery, including serious post-operative complications (2 cases) and poor wound healing (1 case). Patients could not be contacted after discharge and did not attend regular outpatient check-ups (4 cases). Refusal to accept follow-up surveys for personal reasons (4 cases). And loss of contact due to sudden natural disasters in the area (1 case). All of them were excluded from the study, and a total of 141 patients were included.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eGeneral information of participants\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic data of the 141 study subjects showed that the gender ratio of the patients was 50.4% (male) and 49.6% (female) respectively, with a similar composition, and their age was 33.48\u0026plusmn;12.47 years. The marital status was only married and unmarried, 83 (58.9%) and 58 (41.1%) cases respectively. The largest proportion of the respondents had a bachelor\u0026rsquo;s degree or above in education, with 39 cases (27.7%). In terms of disease-related data, tumour site was predominantly lower limb (95 cases, 67.4%) and tumour type was predominantly giant cell tumour of bone (33 cases, 23.4%) and osteosarcoma (29 cases, 20.6%). The study population included 83 cases (58.9%) of benign bone tumours and 58 cases (48.1%) of malignant tumours. As junctional tumours such as giant cell tumour of bone was already able to have distinct benign and malignant features when pathological staging was done, they could be directly classified as benign or malignant bone tumours at the time of analysis, based on the pathological report results. In terms of the type of surgery, the surgery was mainly divided into resection of the tumour segment, supplemented by plate and screw internal fixation, joint fusion, autologous/allogeneic bone graft and tumour joint prosthesis or modular joint prosthesis replacement, with some patients with malignant tumours undergoing additional peri-tumour lymph node dissection, and all patients undergoing soft tissue repair at the surgical site. In this study, 47 patients (33.3%) underwent bone tumour resection plus bone reconstruction and 48 patients (34.0%) also underwent bone tumour resection plus tumour arthroplasty. The average length of stay for patients undergoing bone tumour surgery was 7.67\u0026plusmn;2.34 days. Additionally, the mean values of PTGI-C at different monitoring time points were 41.24\u0026plusmn;21.94, 44.56\u0026plusmn;23.33, and 40.69\u0026plusmn;22.63, respectively and repeated measures analysis of variance with Univariate showed that the differences of PTGI-C measured at different time points were statistically significant (F=3.372, P=0.02). The general information of the 141 subjects is shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 General information of bone tumour patients with surgery\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTrait\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComposition Ratio (%) /\u003c/strong\u003e\u003cstrong\u003e`\u003c/strong\u003e\u003cstrong\u003ex\u0026plusmn;s / M(QR\u003csup\u003e1\u003c/sup\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e50.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003ey\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e33.48\u0026plusmn;12.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eKg/m\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.33\u0026plusmn;3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e41.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eJunior high school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eHigh school and secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eJunior colleges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBachelor degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e95.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome Monthly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 194px;\"\u003e\n \u003cp\u003e＜2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e2000~5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e5001~10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e＞10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e14.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e58.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e19.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite of the tumour\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u0026nbsp;Upper limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e28.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eLower limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e67.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eGiant cell tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp; 33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eOsteosarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp; 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Fibrogenic tumours \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp; 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Other mesenchymal tumours \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp; 26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eCartilage-origin tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistology\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eBenign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e58.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eMalignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e48.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eTumour segment resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eTumour segment resection and elongated bone reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003eTumour segment resection plus joint replacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp; Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImplants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e66.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e61.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime since diagnosis (month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5 [2, 12]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChemotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e70.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep quality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e38.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003epoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep duration/per day (hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e＜5h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e5~6h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e22.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e6~7h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e31.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 227px;\"\u003e\n \u003cp\u003e＞7h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 350px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003edays\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e7.67\u0026plusmn;2.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTGI-C\u003csup\u003e2\u003c/sup\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e41.24\u0026plusmn;21.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eT2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e44.56\u0026plusmn;23.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e40.69\u0026plusmn;\u0026nbsp;22.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e46.62\u0026plusmn;22.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eF=3.372, P=0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote:\u003csup\u003e\u0026nbsp;1\u003c/sup\u003e\u003c/strong\u003eIndicates Interquartile range. \u003csup\u003e2\u003c/sup\u003ePTGI-C: Chinese version of the Post Traumatic Growth Inventory\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eModel Fitting and Selection of PTG Trajectories\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePTGI-C scores of patients at 4 time points were taken as the observation index with setting the free estimation of time parameters, and 1-5 categories were extracted successively for model fitting analysis. The results show that only 2 types of models have significant LMR, LRT and BLRT values. At the same time, with the increase of the number of classifications, AIC, and aBIC values increased first and then decreased. The BIC increases and Entropy reaches its maximum value (Table 2). Above all, this study applied the 2 LCGM model of categories and combining the characteristics of the trajectory of change in PTGI-C, PTGI-C were divided into 2 subgroups. The results showed that category group 1 had a higher PTGI-C score at the admission (intercept =44.276) and mean of the PTGI-C with an overall increasing trend (slope =5.152 P \u0026lt; 0.001), indicating that the PTG were maintained at a high level. Therefore, category group 1 was named the \u0026ldquo;increasing trajectory group\u0026rdquo;. The PTGI-C score at the admission was lower than that of category 1 (intercept = 35.164) and the entire line was below the average, with an overall decreasing trend (slope =\u0026minus;4.718, P \u0026lt; 0.001), so category 2 was named the \u0026ldquo;decreasing trajectory group\u0026rdquo;. The potential categories of the trajectory of the change in the PTG of the two groups are shown in Table 3 and Figure 1. The scores of PTGI-C for different periods in each group are shown in Table 4, including 91 cases (64.54%) in the \u0026ldquo;increasing trajectory group\u0026rdquo;, and 60 cases (35.46%) in the \u0026ldquo;decreasing trajectory group\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Fitting Results of LCGM\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Classes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esaBIC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEntropy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLMR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLRT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBLRT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4848.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4874.706\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4846.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4840.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4875.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4837.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.0399*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.0389*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.0150*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4841.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4885.487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4838.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.743\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.6690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.6849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.4350\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4836.849\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4889.927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4832.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.3986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.4119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.2500\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e4834.656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4896.580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e4830.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.2341\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.2624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 59px;\"\u003e\n \u003cp\u003e0.0609\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e AIC, Akaike information criterion. BIC, Bayesian information criterion. saBIC, sample size adjusted BIC. LMR, LoMendell likelihood ratio test. LRT, Likelihood Ratio Test. \u0026nbsp;BLRT, bootstrap likelihood ratio test. * indicates P＜0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Intercept and Slope of Each Class\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClass\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntercept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlope\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eClass 1(Increasing trajectory group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e44.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eP＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003eP＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eClass 2(Decreasing trajectory group)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e35.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eP＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-4.718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e \u003cstrong\u003eUnivariate Analysis of Patient-Reported Outcome Trajectories\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProjects\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncreasing trajectory Group (n=91)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecreasing trajectory Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=50)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003cstrong\u003e2\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e/t\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e44 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e27(54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e47 (51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e23(46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eyear\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e＜27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e42(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.042*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e28-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e26(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e23(46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e＞40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e23(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14(28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eKg/m\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e22.16\u0026plusmn;3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22.65\u0026plusmn;3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e47(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36(72.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.019*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e44 (48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14(28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eJunior high school\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e21(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.160\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eHigh school and secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e22(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eJunior colleges\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e18(19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16(32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e30(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e5(5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e86(94.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e48(96.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIncome Monthly (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e＜2000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e17(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.775\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2000~5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e32(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e5001~10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e29(31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e＞10000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e13(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e50(54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32(64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCounty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e19(20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCountryside\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e22(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSite of the tumour (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eUpper limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e26(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14(28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.261\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLower limbs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e63(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e32(64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2(2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGiant cell tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e25(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e10.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eOsteosarcoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e20(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFibrogenic tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e7(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eOther mesenchymal tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e17(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eCartilage-origin tumour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e18(19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8(16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistology (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eBenign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e57(62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26(52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMalignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e34(37.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24(48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgery type (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTumour segment resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e18(19.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17(34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTumour segment resection and elongated bone reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e32(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eTumour segment resection plus joint replacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e33(36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15(30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;8(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eImplants (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e62(68.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31(32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e29(31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of surgery (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e58(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e29(58.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e33(36.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e21(42.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime since diagnosis (month)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e6 [2,12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5[2.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2048.00\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChemotherapy (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eYES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e23(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eNO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e68(74.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31(61.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep quality (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.33\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.752\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e31(34.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19(38.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e37(40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17(34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003epoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e19(20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSleep duration/per day (hours)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e＜5h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e18(19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e13(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e5~6h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e22(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e6~7h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e26(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e18(36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e＞7h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e25(27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital stay\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003edays\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e7.67\u0026plusmn;2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7.68\u0026plusmn;2.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCoping style\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e24(26.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6(12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eEvasive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e67(73.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e44(88.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCIES-R\u003csup\u003e3\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e14 [7,24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e10 [3,18]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1825.50\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e27 [9,32]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12.5 [5, 28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1674.50\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTS\u003c/strong\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eHigh level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e48(52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16(32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eLow level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e43(47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e34(68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.91\u0026plusmn;1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.24\u0026plusmn;2.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e4.20\u0026plusmn;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.64\u0026plusmn;2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.98\u0026plusmn;1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3.08\u0026plusmn;1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e2.35\u0026plusmn;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.22\u0026plusmn;1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e244.94\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e＜\u003c/strong\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTGI-C\u003csup\u003e5\u0026nbsp;\u003c/sup\u003e\u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e45.42\u0026plusmn;20.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e33.21\u0026plusmn;21.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT2\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e50.15\u0026plusmn;20.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e34.41\u0026plusmn;25.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e51.73\u0026plusmn;18.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19.98\u0026plusmn;12.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 77px;\"\u003e\n \u003cp\u003e60.34\u0026plusmn;13.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e19.78\u0026plusmn;11.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e100.41\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e＜\u003c/strong\u003e\u003cstrong\u003e0.001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: * Indicates P＜0.05. \u003csup\u003e1\u0026nbsp;\u003c/sup\u003eIndicates Fisher\u0026rsquo;s exact probability method. \u003csup\u003e2\u003c/sup\u003e Indicates Mann-Whitney U test method. \u003csup\u003e3\u003c/sup\u003eCIES-R: The Chinese translation of the Impact of Event Scale-Revised. \u003csup\u003e4\u0026nbsp;\u003c/sup\u003ePTS: Post Traumatic Stress. The Cut-off of CIES-R was 26. CIES-R\u0026ge;26 indicates higher PTS while CIES-R\u0026lt;26 indicates lower status of PTS.\u003csup\u003e\u0026nbsp;5\u003c/sup\u003ePTGI-C: Chinese version of the Post Traumatic Growth Inventory.\u003csup\u003e\u0026nbsp;6\u0026nbsp;\u003c/sup\u003eIndicates results of repeated measures analysis of variance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eUnivariate analysis and Logistic Regression Analysis of Factors Influencing the Type of PTG\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe results showed that the two trajectory categories of age, marital status, coping style, CIES-R on post-operative 2 days and Post Traumatic Stress (PTS) were statistically significant (P\u0026lt;0.05) when comparing PTGI-C scores, as shown in Table 4. The variables with statistical significance in the univariate analysis (P＜0.10) were used as independent variables, and the two groups of trajectory categories were used as dependent variables for the Binomial Logistic Regression Analysis. The forward stepwise regression method based on maximum likelihood estimation was used for the analysis. The influencing factors for the decreasing trajectory group relative to the increasing trajectory group were marital status, type of tumour, and PTS (P＜0.05). The results showed that unmarried (OR=0.381, P=0.019), low level of PTS (OR=2.666, P=0.015), Giant cell tumour (OR=0.223, P=0.047), Fibrogenic tumours (OR=0.127, P=0.007), cartilaginous origin tumour (OR=0.194, P=0.034), and other tumours (OR=0.169, P=0.023) were predictive factors for PTG trajectory. The fit of this Binary Logistic regression model was P= 0.947(P＞0.05) in the Hosmer Lemeshow test. The Omnibus test showed that the model was significant in general (P=0.002＜0.05), and the model predictive power of Binomial Logistic Regression fitting equation was 66.0%. The result was shown in table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Logistic Regression Analysis of Patient Reported Outcome Trajectories\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWald\u003c/strong\u003e\u003cstrong\u003ec\u003c/strong\u003e\u003cstrong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e (Ref =Married)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.481\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.381[0.170-0.855]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eGiant cell tumour (Ref = Osteosarcoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-1.503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.223[0.051, 0.980]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eFibrogenic tumour (Ref =\u0026nbsp;Osteosarcoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-2.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e7.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.127[0.028,0.573]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eOther mesenchymal tumour (Ref =\u0026nbsp;Osteosarcoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.505[0.101,2.517]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eCartilage-origin tumour (Ref =\u0026nbsp;Osteosarcoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-1.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.774\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.194[0.043,0.885]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003eOther (Ref =\u0026nbsp;Osteosarcoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-1.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.780\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.169[0.037,0.780]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 262px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePTS\u003csup\u003e1\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e\u0026nbsp;\u003c/sup\u003e(Ref = low level)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2.666[1.213, 5.860]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: Omnibus Tests of Model Coefficients showed P=0.002＜0.05. Hosmer and Lemeshow showed P=0.947＞0.05. Model predictive power was 66.0%. \u003csup\u003e1\u0026nbsp;\u003c/sup\u003eIndicates\u003csup\u003e\u0026nbsp;\u003c/sup\u003ePost Traumatic Stress.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this study was the first one which focused on the trajectories of PTG among bone tumour patients at the early time after surgery. It was also the first study to explore the categories and predictive factors of PTG trajectories when patients finished the surgery or plus other therapy. We found that the patients could be divided into two group basing on the PTG trajectories including increasing group and decreasing group. It was obvious that the patients in increasing group experienced continuous growth of PTG as time goes on while the PTG level of decreasing group patients gradually fell with time. The PTG of patients in the growth group was also consistently higher than the average of all patients. The other group was consistently below average. Interestingly, the age, marital status, coping style, CIES-R on post-operative 2 days, level of PTS, and categories of tumours would predict the tendency of PTG basing on univariate analysis and multivariate analysis.\u003c/p\u003e\n\u003cp\u003eWe selected a total of four time points for repeated measurements of PTG, including 3 days before surgery (T1), 2 days after surgery (T2), 15 days after surgery (T3), and 30 days after surgery (T4). Because patients were usually admitted to hospital 3 days before surgery in China, when general information will be collected clearly, which will ensure the completeness and accuracy of the information. The time chosen for follow-up was based on the patient’s post-operative recovery process. They would have their wound stitches removed in the outpatient clinic on 15 days after surgery, at which point the wound would have healed and the HCWs would be available to guide the patient through the full recovery process. In addition, their first post-operative review in the outpatient clinic on 30 days after surgery, which was a time of high incidence of various post-operative complications in bone tumours and was a time when Orthopaedic surgery patients should emphasize. Patients with malignant bone tumours who also required a combination of neoadjuvant chemotherapy postoperatively, then typically begin their first postoperative chemotherapy session 30 days later which may result in new traumatic events [\u003ca href=\"#_ENREF_40\" title=\"Gong, 2023 #20\"\u003e40\u003c/a\u003e]. Therefore, HCWs had more opportunities to contact with patients during this period, for example, psychological support[\u003ca href=\"#_ENREF_41\" title=\"Wu, 2023 #21\"\u003e41\u003c/a\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, interests in the experiences of bone tumour patients who just went through the diagnosis and therapy induced us emphasize on the PTG level during 1 month after surgery. A stressful event may be enough to challenge a set of deeply held assumptions about the world and the self. For some, this would lead to PTS, while for others, it might lead to positive psychological changes, a person's response to a challenge was beneficial [\u003ca href=\"#_ENREF_30\" title=\"Tedeschi, 2004 #13\"\u003e30\u003c/a\u003e].\u0026nbsp;Based on the theoretical model of posttraumatic growth, it can be inferred that in the early stage of traumatic events, individuals need to reconstruct all aspects such as schema and core values to produce PTG, which requires a certain reaction time[\u003ca href=\"#_ENREF_42\" title=\"Shand, 2015 #22\"\u003e42\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_43\" title=\"Stish, 2015 #23\"\u003e43\u003c/a\u003e], and the length of this time was still inconclusive. Hence, most of the prior research reported the long-term PTG level of patients who had been diagnosed or treated for years or even decades, but few focused on the changes of PTG in patients with tumours undergoing therapeutic surgery for the first time. However, latest studies have shown that PTG occurring in the short term after traumatic events was often more meaningful, which would affect the patient’s long-term PTG level, functional recovery and quality of life\u0026nbsp;[\u003ca href=\"#_ENREF_44\" title=\"Marziliano, 2020 #24\"\u003e44\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_45\" title=\"Turner, 2018 #25\"\u003e45\u003c/a\u003e]\u0026nbsp;In this study, the median time to diagnosis of the patients was 5 [2-12] months, and all patients had their first bone tumour treatment surgery. If the patients and risk factors of PTG reduction trajectory could be identified in the early stage of tumour-related traumatic events (including tumour treatment and diagnosis)\u0026nbsp;[\u003ca href=\"#_ENREF_46\" title=\"Andrykowski, 2015 #26\"\u003e46\u003c/a\u003e], it would be effective to the improvement or maintenance of PTG levels in the later stage.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnlike previous studies[\u003ca href=\"#_ENREF_47\" title=\"Harding, 2018 #27\"\u003e47\u003c/a\u003e], we did not only focus on the level of PTG in patients with tumour but also the global change after 1 month with surgery. Based on the assumption of population homogeneity, we further explored the category of potential trajectories of PTG generated by individual heterogeneity. Patients undergoing bone tumour surgery, including those with benign and malignant bone tumours, had two groups of latent classes of PTG trajectories. In a longitudinal study of patients with head and neck cancer, positive psychology increased and then decreased early in diagnosis and treatment\u0026nbsp;[\u003ca href=\"#_ENREF_47\" title=\"Harding, 2018 #27\"\u003e47\u003c/a\u003e]. Fauske et al conducted the qualitative study which showed that patients with bone sarcoma were more likely to have emotional problems\u0026nbsp;[\u003ca href=\"#_ENREF_15\" title=\"Fauske, 2019 #2\"\u003e15\u003c/a\u003e]. It was also reported that different categories of PTG change trajectories existed in different tumour population[\u003ca href=\"#_ENREF_48\" title=\"Menger, 2021 #28\"\u003e48\u003c/a\u003e]. However, they both focused on specific group with tumour and did not recognize the heterogeneity of individuals in this population. Through the establishment of latent category trajectory, we were able to more accurately identify the PTG\u0026nbsp;ascending group and decline group. On this basis, precise intervention for high-risk bone tumours with decreased PTG could be targeted. It was particularly important to explore and monitor the predictors of PTG growth trajectory and decline trajectory which also guided us to do further research.\u003c/p\u003e\n\u003cp\u003eAfter confirming the change trajectory of PTG in different populations, we also identify the predictors or influencing factors of PTG reduction trajectory. Firstly, the unmarried status was a protective factor\u0026nbsp;for the decrease of PTG which was a novel finding. Differently, relevant studies have found that being married was a protective factor for low PTG levels in cancer patients [\u003ca href=\"#_ENREF_49\" title=\"Kim, 2021 #29\"\u003e49\u003c/a\u003e]. The study inferred that married people received more social support than unmarried people which was a mediator of marital status and PTG in Korea. However, this may be related to the gender of the sample included in. Previous studies tended to analyse PTG levels only in men or women, but our study included both male and female patients for analysis[\u003ca href=\"#_ENREF_49\" title=\"Kim, 2021 #29\"\u003e49\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_50\" title=\"Cui, 2017 #30\"\u003e50\u003c/a\u003e]. Moreover, in the cultural background of China,\u0026nbsp;the family system of married patients has been transformed from a large family system to a small “nuclear family” which cantered on husband and wife\u0026nbsp;[\u003ca href=\"#_ENREF_31\" title=\"Wang, 2011 #64\"\u003e31\u003c/a\u003e]. The family support of unmarried patients often came from all family members, while the family support of married patients was mainly from spouse\u0026nbsp;[\u003ca href=\"#_ENREF_51\" title=\"Xu, 2023 #65\"\u003e51\u003c/a\u003e]. If the level of marital adjustment was too low, it was likely to affect the early PTG level\u0026nbsp;[\u003ca href=\"#_ENREF_52\" title=\"Suo, 2023 #31\"\u003e52\u003c/a\u003e]. Therefore, to maintain a high level of PTG in patients with bone tumours over the long term, HCWs should identify how marital status affects PTG. Whether married or unmarried patients, we should find the risk factors that affect PTG in time, and carry out psychological support to them, such as health education for family members to improve social support and patient’ care skills. In this way, patients could be guaranteed effective social and medical support during treatment, regardless of family structure and marital status.\u003c/p\u003e\n\u003cp\u003eSecondly, the active coping strategies could help patients build up high level of PTG. Our findings were like other research’s outcomes. A cross-sectional study of Asian cancer patients also showed that positive coping style was beneficial for personal growth [\u003ca href=\"#_ENREF_53\" title=\"Fujimoto, 2021 #32\"\u003e53\u003c/a\u003e]. Gori and his colleges also confirmed the relationship between coping style and PTG level\u0026nbsp;[\u003ca href=\"#_ENREF_54\" title=\"Gori, 2021 #33\"\u003e54\u003c/a\u003e]. However, the predictive and practical effects of positive coping styles on the trajectory of PTG change cannot be well interpreted in aforementioned studies. Although many different components were thought to interact in intricate ways to cause post-traumatic development, cognitive processes seem to play a specific role in these interactions\u0026nbsp;[\u003ca href=\"#_ENREF_55\" title=\"Szcześniak, 2022 #34\"\u003e55\u003c/a\u003e].Tumour, on the other hand, was an intensely signifying event that destroys an individual’s sense of self and somatopsychic link, necessitating an introspective concentration, developing awareness, and meaning-making of one's own experience to permit complete elaboration[\u003ca href=\"#_ENREF_56\" title=\"Walsh, 2018 #35\"\u003e56\u003c/a\u003e]. Considering prior research and the present study, we might infer that active coping strategies were able to help bone tumour patients actively complete cognitive processing of traumatic events and reconstruct the world assumption through deliberate rumination\u0026nbsp;[\u003ca href=\"#_ENREF_55\" title=\"Szcześniak, 2022 #34\"\u003e55\u003c/a\u003e]. Therefore, identifying bone tumour surgery patients who had evasive coping strategies and teaching them to cope with traumatic events may be beneficial for medical staff to improve PTG. When patients were in a coping-avoidance state, HCWs should teach them ways to cope with the impact of the tumour. For example, it was necessary to inform them about patients who have gotten better with treatment. By hinting at some case outcomes of treatment success, the patient’s confidence in coping would be improved a lot.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThirdly, there were also significant differences in PTG levels among patients with different types of bone tumours. Compared with osteosarcoma, other types of bone tumours were protective factors for PTG reduction.\u0026nbsp;Osteosarcoma, which ranks first among malignant bone-related cancers in adolescents, had complex heterogeneity and abnormally generated immature osteoid matrix[\u003ca href=\"#_ENREF_57\" title=\"Li, 2022 #36\"\u003e57\u003c/a\u003e]. About 35%-45% of patients with osteosarcoma have chemoresistance and poor response to treatment, and these patients are prone to distant metastasis. The 5-year survival rate of patients with distant metastasis was less than 20%\u0026nbsp;[\u003ca href=\"#_ENREF_58\" title=\"Zhao, 2021 #37\"\u003e58\u003c/a\u003e]. Hence, once diagnosed as osteosarcoma, it must bring a heavy blow to the patients and their families. In the early stages of treatment, it was often difficult to maintain a high level of PTG. This suggests that it was necessary for nurses to provide psychological support to patients with malignant tumour. The treatment of bone tumours was complex and lengthy. We cannot avoid the continuous influence of various traumatic events on individuals. Whether it was the diagnosis of tumours, the persistence of treatment, the prognosis, the change of body image, and the change of functional autonomy and/or role, may be repeated throughout the whole life cycle of patients with bone tumours, especially those with malignant bone tumours[\u003ca href=\"#_ENREF_59\" title=\"Tang, 2015 #38\"\u003e59\u003c/a\u003e]. In the context of understanding the dynamic changes of PTG, timely intervention for high-risk groups in time when low levels of PTG are likely to occur was bound to improve the psychological state of patients and the prognosis of the disease.\u003c/p\u003e\n\u003cp\u003eFinally, this study validated the positive correlation between PTS and PTG in patients with bone tumours. PTS was one of the most frequently reported negative psychological phenomena in cancer patients. It mainly included post-traumatic stress disorder (PTSD) and post-traumatic stress symptom (PTSS)[\u003ca href=\"#_ENREF_60\" title=\"Jim, 2008 #39\"\u003e60\u003c/a\u003e]. They were clinical diseases and Sub-syndromic symptoms, respectively\u0026nbsp;[\u003ca href=\"#_ENREF_44\" title=\"Marziliano, 2020 #24\"\u003e44\u003c/a\u003e].\u0026nbsp;Previous research evaluating the association between PTS and PTG found varying results in terms of the degree, direction, and linearity of this relationship\u0026nbsp;[\u003ca href=\"#_ENREF_44\" title=\"Marziliano, 2020 #24\"\u003e44\u003c/a\u003e]\u0026nbsp;Some research, such as\u0026nbsp;[\u003ca href=\"#_ENREF_61\" title=\"Dougall, 2017 #40\"\u003e61\u003c/a\u003e], claim a positive association between PTS and PTG, while others, such as\u0026nbsp;[\u003ca href=\"#_ENREF_62\" title=\"Arpawong, 2013 #41\"\u003e62\u003c/a\u003e], claim a negative relationship. Our findings were in line with the research results of Morrill[\u003ca href=\"#_ENREF_63\" title=\"Morrill, 2008 #42\"\u003e63\u003c/a\u003e], \u0026nbsp; Groarke[\u003ca href=\"#_ENREF_32\" title=\"Groarke, 2017 #14\"\u003e32\u003c/a\u003e], Chen[\u003ca href=\"#_ENREF_64\" title=\"Chen, 2019 #43\"\u003e64\u003c/a\u003e]\u0026nbsp;and other scholars, and was also the view advocated by most empirical studies at present. Some researcher believed that the positive correlation between the two was due to the fact the more threatening an event was, the more it would promote the alternate occurrence of growth and stress response. Then they would lead to a stronger relationship between the two structures\u0026nbsp;[\u003ca href=\"#_ENREF_44\" title=\"Marziliano, 2020 #24\"\u003e44\u003c/a\u003e,\u0026nbsp;\u003ca href=\"#_ENREF_65\" title=\"Baník, 2022 #44\"\u003e65\u003c/a\u003e], resulting in the result of both growths. Although a higher level of psychological impact may cause a higher level of PTG, patients need to bear a certain degree of psychological pain. However, a high PTS rate was maladaptive and can hinder the progression of PTG. An individual with an excessive level of PTS could not have the capacity to reconstruct cognition, such as core beliefs, which may form the basis of PTG[\u003ca href=\"#_ENREF_65\" title=\"Baník, 2022 #44\"\u003e65\u003c/a\u003e]. Understanding the link between PTG and PTS was critical for a better understanding of post-traumatic reactions in cancer patients, but it was also critical to understand how they correlate. As nurses, when evaluating the psychological status of patients, we should include both positive and negative psychological states in the evaluation, which was conducive to accurately evaluate all the psychological states of patients with bone tumours, so as to provide more targeted psychological guidance to them and alleviate some of the pain on the premise of creating conditions conducive to PTG. In the future, we still need to explore the threshold of PTS based on studies showing a positive correlation between PTS and PTG. This will facilitate our subsequent intervention to be more precise and effective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study also has several limitations that restrict the findings’ generalizability. Firstly, due to the low incidence and prevalence of bone tumours, only 141 patients with bone tumour surgery were included in this study in one hospital, China. The follow-up time was only one month. In the future, large sample, multi-centre and continuous follow-up participants are still needed to demonstrate the trajectory of PTG and its influencing factors. Second, although the heterogeneity of the sample leads to a reduction in selection bias from the perspective of different bone tumour types, it may also lead to a reduction in internal validity. Although there was no difference between benign and malignant tumours in univariate analysis. However, future studies may consider adopting more complex statistical analysis methods to improve internal validity. Also, it is necessary to consider that other factors may play a role in the development of cancer-related posttraumatic reactions (other personality factors, other life events, perception of stress, etc.), which were not examined in this study. It is worth further investigation in future studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study was a 1-month longitudinal study of patients undergoing bone tumour surgery. Based on the concept of individual heterogeneity, the LCGM was used to confirm the change trend of PTG level in patients with bone tumour surgery into an increased group and a decreased group. Marital status, coping style, tumour type and level of PTS were the influencing factors of PTG decreasing trend group through univariate analysis and logistic regression. This provides empirical and theoretical evidence for the study of positive psychology and mental wellbeing in patients with tumour. It also laid the foundation for HCWs to develop interventions to improve positive psychological outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical considerations were upheld throughout the study, adhering to the principles outlined in the Declaration of Helsinki. The study received approval from the West China Hospital Ethics Committee and all participants provided informed consent by signing consent forms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAuthors, institutions and participants have consent of publication. All authors have reviewed the manuscript before submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThere are no conflicts declared. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYL\u003c/strong\u003e designed the research, collected and analysed the data of bone tumour patients, and drafted this manuscript. \u003cstrong\u003eXFZ\u003c/strong\u003e collected and analysed the data of bone tumour patients. \u003cstrong\u003ePFL\u0026nbsp;\u003c/strong\u003emodified the research design and assisted investigating of data among bone tumour patients and revised the manuscript. \u003cstrong\u003eYTW\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;JW\u0026nbsp;\u003c/strong\u003erevised the statistic model of analysing trend of post traumatic growth among bone tumour surgery patients. \u003cstrong\u003eCQT\u003c/strong\u003e and \u003cstrong\u003eHD\u0026nbsp;\u003c/strong\u003edefined the criteria for participants of the study and supported the idea of methodology of this research. \u003cstrong\u003eJLC\u003c/strong\u003e and \u003cstrong\u003eNN\u0026nbsp;\u003c/strong\u003ecame up with the idea of the research, supervised the process of research and revised the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We are grateful to Professor Richard G. Tedeschi for permission to use the Posttraumatic Growth Inventory (PTGI).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNiu X, Xu H-R, Inwards CY, et al. Primary Bone Tumors: Epidemiologic Comparison of 9200 Patients Treated at Beijing Ji Shui Tan Hospital, Beijing, China, With 10 165 Patients at Mayo Clinic, Rochester, Minnesota. Archives Pathol Lab Med. 2015;139 9:1149\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5858/arpa.2014-0432-OA\u003c/span\u003e\u003cspan address=\"10.5858/arpa.2014-0432-OA\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eScotlandi K, Hattinger CM, Pellegrini E, Gambarotti M, Serra M. Genomics and Therapeutic Vulnerabilities of Primary Bone Tumors, \u003cem\u003eCells\u003c/em\u003e 9, no. 4 (2020): 968. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/cells9040968\u003c/span\u003e\u003cspan address=\"10.3390/cells9040968\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022, \u003cem\u003eCA: A Cancer\u003c/em\u003e. J Clin. 2022;72(1):7\u0026ndash;33. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21708\u003c/span\u003e\u003cspan address=\"10.3322/caac.21708\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGill J, Gorlick R. Advancing therapy for osteosarcoma. Nat Reviews Clin Oncol. 2021;18(10):609\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41571-021-00519-8\u003c/span\u003e\u003cspan address=\"10.1038/s41571-021-00519-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarec-Berard P, Laurence V, Occean B-V, et al. Methotrexate\u0026ndash;Etoposide\u0026ndash;Ifosfamide Compared with Doxorubicin\u0026ndash;Cisplatin\u0026ndash;Ifosfamide Chemotherapy in Osteosarcoma Treatment, Patients Aged 18\u0026ndash;25 Years. J Adolesc Young Adult Oncol. 2020;9(2):172\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1089/jayao.2019.0085\u003c/span\u003e\u003cspan address=\"10.1089/jayao.2019.0085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYu Z, Zhang W, Fang X, Tu C, Duan H. Pelvic Reconstruction With a Novel Three-Dimensional-Printed, Multimodality Imaging Based Endoprosthesis Following Enneking Type I\u0026thinsp;+\u0026thinsp;IV Resection. Front Oncol. 2021;11:629582. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fonc.2021.629582\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2021.629582\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShoaib Z, Fan TM, Irudayaraj JMK. Osteosarcoma mechanobiology and therapeutic targets. Br J Pharmacol. 2021;179(2):201\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/bph.15713\u003c/span\u003e\u003cspan address=\"10.1111/bph.15713\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl Ghoneimy AM, Shehab AM, Farid N. What is the Cumulative Incidence of Revision Surgery and What Are the Complications Associated With Stemmed Cementless Nonextendable Endoprostheses in Patients 18 Years or Younger With Primary Bone Sarcomas About the Knee. Clin Orthop Relat Res. 2022;480(7):1329\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/CORR.0000000000002150\u003c/span\u003e\u003cspan address=\"10.1097/CORR.0000000000002150\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeveryns M, Briand S, Waast D, Touchais S, Hamel A, Gouin F. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis: Incidence, characterization and functional impact, \u003cem\u003eSurgical Oncology\u003c/em\u003e 26, no. 2 (2017): 171\u0026ndash;177. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.suronc.2017.03.005\u003c/span\u003e\u003cspan address=\"10.1016/j.suronc.2017.03.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCiechanowicz D, Kotrych D, Dąbrowski F, Mazurek T. Trends in Diagnosis and Surgical Treatment of Bone Metastases among Orthopedic Surgeons. J Clin Med. 2022;11:15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e4284, https://doi.org/10.3390/jcm11154284\u003c/span\u003e\u003cspan address=\"4284, 10.3390/jcm11154284\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBiermann JS, Chow W, Reed DR, et al. NCCN Guidelines Insights: Bone Cancer, Version 2.2017. J Natl Compr Canc Netw. 2017;15(2):155\u0026ndash;67. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.6004/jnccn.2017.0017\u003c/span\u003e\u003cspan address=\"10.6004/jnccn.2017.0017\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi ZH, Pan Z, Guo H, Fei X, Cheng DD. Yang \u003cem\u003eLong-Term Follow-Up of Biological Reconstruction with Free Fibular Graft after Resection of Extremity Diaphyseal Bone Tumors\u003c/em\u003e. J Clin Med. 2022;11:7225. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/jcm11237225\u003c/span\u003e\u003cspan address=\"10.3390/jcm11237225\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu C, Min L, Zhou Y, et al. Long-term results of uncemented allograft prosthesis composite reconstruction for the tumor in proximal femur: a minimum follow-up of sixty-five months. BMC Musculoskelet Disord. 2021;22(1):128. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12891-021-03991-6\u003c/span\u003e\u003cspan address=\"10.1186/s12891-021-03991-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTaylor MF, Pooley JA. Sarcoma survivors' perspectives on their body image and functional quality of life post-resection/limb salvage surgery. Eur J Cancer Care. 2017;26(6):e12667. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ecc.12667\u003c/span\u003e\u003cspan address=\"10.1111/ecc.12667\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFauske L, Bondevik H, Ahlberg K, Bj\u0026oslash;rndal A. Identifying bone sarcoma survivors facing psychosocial challenges. A study of trajectories following treatment. Eur J Cancer Care. 2019;28(5):e13119. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/ecc.13119\u003c/span\u003e\u003cspan address=\"10.1111/ecc.13119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLuzzati F, Giusti EM, Scotto GM, et al. Quality of life, pain, and psychological factors in patients undergoing surgery for primary tumors of the spine. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2020;28(3):1385\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-019-04965-0\u003c/span\u003e\u003cspan address=\"10.1007/s00520-019-04965-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYenmez NN, Lyons KS. Perceived Body Image and Perceived Control Are Associated With Physical and Mental Health in Individuals With Cancer. Oncol Nurs Forum. 2022;50(1):19\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1188/23.ONF.19-23\u003c/span\u003e\u003cspan address=\"10.1188/23.ONF.19-23\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWalczak BE, Irwin RB. Sarcoma Chemotherapy. J Am Acad Orthop Surg. 2013;21(8):480\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5435/JAAOS-21-08-480\u003c/span\u003e\u003cspan address=\"10.5435/JAAOS-21-08-480\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eD'adamo DR. Appraising the Current Role of Chemotherapy for the Treatment of Sarcoma. Semin Oncol. 2011;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1053/j.seminoncol.2011.09.004\u003c/span\u003e\u003cspan address=\"10.1053/j.seminoncol.2011.09.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. S19-S29.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarrison DJ, Schwartz CL. Osteogenic Sarcoma: Systemic Chemotherapy Options for Localized Disease. Curr Treat Options Oncol. 2017;18(4):24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11864-017-0464-2\u003c/span\u003e\u003cspan address=\"10.1007/s11864-017-0464-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRanft A, Seidel C, Hoffmann C, et al. Quality of Survivorship in a Rare Disease: Clinicofunctional Outcome and Physical Activity in an Observational Cohort Study of 618 Long-Term Survivors of Ewing Sarcoma. J Clin Oncol. 2017;35(15):1704\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1200/JCO.2016.70.6226\u003c/span\u003e\u003cspan address=\"10.1200/JCO.2016.70.6226\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDelgado-Guay M, Parsons HA, Li Z, Palmer JL, Bruera E. Symptom distress in advanced cancer patients with anxiety and depression in the palliative care setting. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2009;17(5):573\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-008-0529-7\u003c/span\u003e\u003cspan address=\"10.1007/s00520-008-0529-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDas S, Roy RN, Das DK, Chakraborty A, Mondal R. Sleep Quality and its various correlates: A community-based study among geriatric population in a community development block of Purba Bardhaman district, West Bengal. J family Med Prim care. 2020;9(3):1510\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4103/jfmpc.jfmpc_1021_19\u003c/span\u003e\u003cspan address=\"10.4103/jfmpc.jfmpc_1021_19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996;9(3):455\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/bf02103658\u003c/span\u003e\u003cspan address=\"10.1007/bf02103658\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSeligman ME, Csikszentmihalyi M. Positive psychology. An introduction. Am Psychol. 2000;55(1):5\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037//0003-066x.55.1.5\u003c/span\u003e\u003cspan address=\"10.1037//0003-066x.55.1.5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAderhold C, Morawa E, Paslakis G, Erim Y. Protective factors of depressive symptoms in adult cancer patients: The role of sense of coherence and posttraumatic growth in different time spans since diagnosis. J Psychosoc Oncol. 2019;37(5):616\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/07347332.2019.1631931\u003c/span\u003e\u003cspan address=\"10.1080/07347332.2019.1631931\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOnu DU, Ugwu D, Orjiakor CT. Events Centrality Moderates the Relationship Between Posttraumatic Growth and Health-Related Quality of Life Among People Living With HIV. J Assoc Nurses AIDS Care. 2019;30(6):668\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/jnc.0000000000000094\u003c/span\u003e\u003cspan address=\"10.1097/jnc.0000000000000094\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaragiorgou O, Evans JJ, Cullen B. Post-traumatic growth in adult survivors of brain injury: a qualitative study of participants completing a pilot trial of brief positive psychotherapy. Disabil Rehabil. 2018;40(6):655\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/09638288.2016.1274337\u003c/span\u003e\u003cspan address=\"10.1080/09638288.2016.1274337\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLindstrom CM, Cann A, Calhoun LG, Tedeschi RG. The relationship of core belief challenge, rumination, disclosure, and sociocultural elements to posttraumatic growth. Psychol Trauma: Theory Res Pract Policy. 2013;5(1):50\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/a0022030\u003c/span\u003e\u003cspan address=\"10.1037/a0022030\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTedeschi RG, Calhoun LG. Posttraumatic Growth: Conceptual Foundations and Empirical Evidence. Psychol Inq. 2004;15(1):1\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/http://www.jstor.org/stable/20447194\u003c/span\u003e\u003cspan address=\"https://doi.org/http://www.jstor.org/stable/20447194\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang J, Chen H, Wang YB, Liu XH. Revision and reliability and validity analysis of post-traumatic growth assessment scale. J Nurs Sci. 2011;7(14):26\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGroarke A, Curtis R, Groarke JM, Hogan MJ, Gibbons A, Kerin M. Post-traumatic growth in breast cancer: how and when do distress and stress contribute? \u003cem\u003ePsycho-oncology\u003c/em\u003e 26, no. 7 (2017): 967\u0026ndash;974. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.4243\u003c/span\u003e\u003cspan address=\"10.1002/pon.4243\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHorowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress, \u003cem\u003ePsychosomatic medicine\u003c/em\u003e 41, no. 3 (1979): 209\u0026ndash;218. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/00006842-197905000-00004\u003c/span\u003e\u003cspan address=\"10.1097/00006842-197905000-00004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuo S, Xin ZQ, Geng LN. Reliability and validity analysis of the revised version of the Event Impact Scale. Chin J Clin Psychol. 2007;15(1):15\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYe Y, Yang K, Fu J. The impact of bereavement on the bereavement and analysis of related factors. Chin J Gen Practitioners. 2018;21(29):3611\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePapava I, Oancea C, Enatescu VR, et al. The impact of coping on the somatic and mental status of patients with COPD: a cross-sectional study. Int J Chronic Obstr Pulm Dis. 2016;11:1343\u0026ndash;51. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/copd.S106765\u003c/span\u003e\u003cspan address=\"10.2147/copd.S106765\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDing Y, Yang Y, Yang X et al. The Mediating Role of Coping Style in the Relationship between Psychological Capital and Burnout among Chinese Nurses, \u003cem\u003ePloS one\u003c/em\u003e 10, no. 4 (2015): e0122128. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0122128\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0122128\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu W, Wei Y, Meng X, Li J. The mediation effects of coping style on the relationship between social support and anxiety in Chinese medical staff during COVID-19. BMC Health Serv Res. 2020;20(1):1007. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-020-05871-6\u003c/span\u003e\u003cspan address=\"10.1186/s12913-020-05871-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStoltzfus JC. Logistic regression: a brief primer. Acad Emerg Med. 2011;18(10):1099\u0026ndash;104. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1553-2712.2011.01185.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1553-2712.2011.01185.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGong T, Luo Y, Lu M, et al. The optimal strategy for 3D-printed uncemented endoprosthesis for the bone defect reconstruction of the distal radius, based on biomechanical analysis and retrospective cohort study. J Surg Oncol. 2023;127(6):1043\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jso.27215\u003c/span\u003e\u003cspan address=\"10.1002/jso.27215\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu F, Fang X, Yuan D, et al. Preserving the rectus femoris and improving limb function after total femoral prosthesis replacement following resection of femoral malignant tumors. Front Oncol. 2023;13:1149342. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fonc.2023.1149342\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2023.1149342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShand LK, Cowlishaw S, Brooker JE, Burney S, Ricciardelli LA. Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis, \u003cem\u003ePsycho-oncology\u003c/em\u003e 24, no. 6 (2015): 624\u0026ndash;634. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.3719\u003c/span\u003e\u003cspan address=\"10.1002/pon.3719\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStish BJ, Ahmed SK, Rose PS, Arndt CA, Laack NN. Patient-Reported Functional and Quality of Life Outcomes in a Large Cohort of Long-Term Survivors of Ewing Sarcoma. Pediatr Blood Cancer. 2015;62(12):2189\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pbc.25710\u003c/span\u003e\u003cspan address=\"10.1002/pbc.25710\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarziliano A, Tuman M, Moyer A. The relationship between post-traumatic stress and post-traumatic growth in cancer patients and survivors: A systematic review and meta-analysis, \u003cem\u003ePsycho-oncology\u003c/em\u003e 29, no. 4 (2020): 604\u0026ndash;616. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.5314\u003c/span\u003e\u003cspan address=\"10.1002/pon.5314\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTurner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer: A systematic review and meta-analysis, \u003cem\u003ePsycho-oncology\u003c/em\u003e 27, no. 4 (2018): 1100\u0026ndash;1109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.4577\u003c/span\u003e\u003cspan address=\"10.1002/pon.4577\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAndrykowski MA, Steffens RF, Bush HM, Tucker TC. Lung Cancer Diagnosis and Treatment as a Traumatic Stressor in DSM-IV and DSM-5: Prevalence and Relationship to Mental Health Outcomes. J Trauma Stress. 2015;28(3):206\u0026ndash;13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/jts.22005\u003c/span\u003e\u003cspan address=\"10.1002/jts.22005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarding SA. The trajectory of positive psychological change in a head and neck cancer population. Int J Oral Maxillofacial Surg. 2018;47(5):578\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijom.2017.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.ijom.2017.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMenger F, Mohammed Halim NA, Rimmer B, Sharp L. Post-traumatic growth after cancer: a scoping review of qualitative research. Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2021;29(11):7013\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-021-06253-2\u003c/span\u003e\u003cspan address=\"10.1007/s00520-021-06253-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKim Y, Kim Y, Kwak Y. Factors associated with post-traumatic growth in male patients with rectal cancer: A cross-sectional study. Eur J Oncol Nurs. 2021;54:102028. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejon.2021.102028\u003c/span\u003e\u003cspan address=\"10.1016/j.ejon.2021.102028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCui C, Wang K, An J, Jin C. Current status and influencing factors of post-traumatic growth in maintenance hemodialysis. Int J Nurs Sci. 2017;4(4):362\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ijnss.2017.09.008\u003c/span\u003e\u003cspan address=\"10.1016/j.ijnss.2017.09.008\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu HZ, Wang TF, Contract M. Family Wealth Accumulation and Subjective Class Identity Formation: An Empirical Study Based on Chinese Family Tracking Survey data, \u003cem\u003eJournal of Sun Yat-sen University (Social Science Edition)\u003c/em\u003e 63, no. 3 (2023): 137\u0026ndash;151. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13471/j.cnki.jsysusse.2023.03.015\u003c/span\u003e\u003cspan address=\"10.13471/j.cnki.jsysusse.2023.03.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSuo R, Ye F, Xie M, et al. The relationship of marital adjustment and posttraumatic growth in female breast cancer patients and their husbands. Psychol Health Med. 2023;28(2):401\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13548506.2022.2067339\u003c/span\u003e\u003cspan address=\"10.1080/13548506.2022.2067339\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFujimoto T, Okamura H. The influence of coping types on post-traumatic growth in patients with primary breast cancer. Jpn J Clin Oncol. 2021;51(1):85\u0026ndash;91. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/jjco/hyaa159\u003c/span\u003e\u003cspan address=\"10.1093/jjco/hyaa159\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGori A, Topino E, Sette A, Cramer H. Pathways to post-traumatic growth in cancer patients: moderated mediation and single mediation analyses with resilience, personality, and coping strategies. J Affect Disord. 2021;279:692\u0026ndash;700. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jad.2020.10.044\u003c/span\u003e\u003cspan address=\"10.1016/j.jad.2020.10.044\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzcześniak M, Madej D, Bielecka G. Relationship between World Assumptions and Post-Traumatic Growth among Polish Cancer Patients: Moderating Effect of Rumination. Int J Environ Res Public Health. 2022;19(19):12444. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph191912444\u003c/span\u003e\u003cspan address=\"10.3390/ijerph191912444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWalsh DMJ, Groarke AM, Morrison TG, Durkan G, Rogers E, Sullivan FJ. Measuring a new facet of post traumatic growth: Development of a scale of physical post traumatic growth in men with prostate cancer. PLoS ONE. 2018;13(4):e0195992. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0195992\u003c/span\u003e\u003cspan address=\"10.1371/journal.pone.0195992\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLi HB, Huang G, Tu J et al. METTL14-mediated epitranscriptome modification of MN1 mRNA promote tumorigenicity and all-trans-retinoic acid resistance in osteosarcoma, \u003cem\u003eEBioMedicine\u003c/em\u003e 82, no. (2022): 104142. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ebiom.2022.104142\u003c/span\u003e\u003cspan address=\"10.1016/j.ebiom.2022.104142\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhao X, Wu Q, Gong X, Liu J, Ma Y. Osteosarcoma: a review of current and future therapeutic approaches. Biomed Eng Online. 2021;20(1):24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12938-021-00860-0\u003c/span\u003e\u003cspan address=\"10.1186/s12938-021-00860-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang ST, Lin KC, Chen JS, Chang WC, Hsieh CH, Chou WC. Threatened with death but growing: changes in and determinants of posttraumatic growth over the dying process for Taiwanese terminally ill cancer patients, \u003cem\u003ePsycho-oncology\u003c/em\u003e 24, no. 2 (2015): 147\u0026ndash;154. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.3616\u003c/span\u003e\u003cspan address=\"10.1002/pon.3616\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJim HS, Jacobsen PB. Posttraumatic stress and posttraumatic growth in cancer survivorship: a review. Cancer J. 2008;14(6):414\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/PPO.0b013e31818d8963\u003c/span\u003e\u003cspan address=\"10.1097/PPO.0b013e31818d8963\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDougall AL, Swanson J, Kyutoku Y, Belani CP, Baum A. Posttraumatic Symptoms, Quality of Life, and Survival among Lung Cancer Patients. J Appl Biobehavioral Res. 2017;22(3):e12065. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jabr.12065\u003c/span\u003e\u003cspan address=\"10.1111/jabr.12065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eArpawong TE, Oland A, Milam JE, Ruccione K, Meeske KA. Post-traumatic growth among an ethnically diverse sample of adolescent and young adult cancer survivors, \u003cem\u003ePsycho-oncology\u003c/em\u003e 22, no. 10 (2013): 2235\u0026ndash;2244. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.3286\u003c/span\u003e\u003cspan address=\"10.1002/pon.3286\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorrill EF, Brewer NT, O'neill SC et al. The interaction of post-traumatic growth and post-traumatic stress symptoms in predicting depressive symptoms and quality of life, \u003cem\u003ePsycho-oncology\u003c/em\u003e 17, no. 9 (2008): 948\u0026ndash;953. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.1313\u003c/span\u003e\u003cspan address=\"10.1002/pon.1313\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChen HM, Chen VC, Hsiao HP, et al. Correlations And Correlates Of Post-Traumatic Growth And Post-Traumatic Stress Symptoms In Patients With Breast Cancer. Neuropsychiatr Dis Treat. 2019;15:3051\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/ndt.S218450\u003c/span\u003e\u003cspan address=\"10.2147/ndt.S218450\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBan\u0026iacute;k G, Dědov\u0026aacute; M, Vargov\u0026aacute; L. Cancer-related posttraumatic growth and posttraumatic stress: how are they connected and what are their correlates? Supportive care cancer: official J Multinational Association Supportive Care Cancer. 2022;30(10):8183\u0026ndash;92. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-022-07252-7\u003c/span\u003e\u003cspan address=\"10.1007/s00520-022-07252-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bone tumour, Influencing factors, Postoperative period, Post traumatic growth, Post traumatic stress, Surgery","lastPublishedDoi":"10.21203/rs.3.rs-7084287/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7084287/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eTo investigate the predominant factors predicting downtrend post-traumatic growth for patients after bone tumour surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe conducted a longitudinal observational study with convenience sampling. Follow-up examinations were conducted every two weeks over a total follow-up period of one month. PTG levels were measured using the Chinese version of the Post Traumatic Growth Inventory (PTGI-C). Latent Category Growth Model (LCGM) was applied to explore the latent trajectory categories of PTG. Univariate and multivariate analyses were conducted to explore the predictors and influencing factors for patients with different trajectories.\u003c/p\u003e\u003ch2\u003eClinical trial number:\u003c/h2\u003e\u003cp\u003eChiCTR2300074170 (Registration Date: 1st August 2023)\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 153 patients were included in the study, and 141 patients completed the follow-up. The means of PTGI-C at different monitoring time were 41.24\u0026thinsp;\u0026plusmn;\u0026thinsp;21.94, 44.56\u0026thinsp;\u0026plusmn;\u0026thinsp;23.33, and 40.69\u0026thinsp;\u0026plusmn;\u0026thinsp;22.63, respectively. Repeated measures analysis of variance with Univariate revealed statistically significant differences in PTGI-C across different time (F\u0026thinsp;=\u0026thinsp;3.372, P\u0026thinsp;=\u0026thinsp;0.02). Patients were categorized into two latent subgroups: an increasing group (intercept\u0026thinsp;=\u0026thinsp;44.276, slope\u0026thinsp;=\u0026thinsp;5.152, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and a decreasing group (intercept\u0026thinsp;=\u0026thinsp;35.164, slope\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;4.718, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) based on two-category LCGM model. Logistic regression analysis results indicated that being unmarried (OR\u0026thinsp;=\u0026thinsp;0.381, P\u0026thinsp;=\u0026thinsp;0.019), low level of post-traumatic symptoms (OR\u0026thinsp;=\u0026thinsp;2.666, P\u0026thinsp;=\u0026thinsp;0.015) which was the most influential, giant cell tumour (OR\u0026thinsp;=\u0026thinsp;0.223, P\u0026thinsp;=\u0026thinsp;0.047), fibrogenic tumours (OR\u0026thinsp;=\u0026thinsp;0.127, P\u0026thinsp;=\u0026thinsp;0.007), cartilaginous origin tumour (OR\u0026thinsp;=\u0026thinsp;0.194, P\u0026thinsp;=\u0026thinsp;0.034), and other tumours (OR\u0026thinsp;=\u0026thinsp;0.169, P\u0026thinsp;=\u0026thinsp;0.023) were predictive factors for the PTG trajectory.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe classification of PTG change trajectory suggested different positive psychological processes in patients with bone tumours. Identifying the influencing factors of patients in the PTG decline trend group can guide nurses to provide effective intervention in time.\u003c/p\u003e","manuscriptTitle":"What are the predominant factors predicting downtrend post-traumatic growth for patients after bone tumour surgery?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 10:47:13","doi":"10.21203/rs.3.rs-7084287/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-09T14:47:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-03T02:31:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-31T22:30:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"124171155412318237417750260566862267712","date":"2026-03-30T20:41:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294679951512831830966898608266631406927","date":"2026-03-26T10:08:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-24T13:08:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291068184352525692345859685672755921055","date":"2025-09-12T07:54:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-03T16:07:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-03T08:39:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-11T18:45:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-08T03:44:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-08-08T03:40:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fda4fbc-1a86-45af-b97e-447ebd4f395d","owner":[],"postedDate":"September 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-14T11:24:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-11 10:47:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7084287","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7084287","identity":"rs-7084287","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}