Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.
Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA.
BMC Cancer. 2019 Nov 28;19(1):1156. doi: 10.1186/s12885-019-6385-7.
Personalized therapy for bone metastases should consider the patients' remaining lifespan. Estimation of survival can be facilitated with scoring tools. A new tool was developed, specifically designed to estimate 12-month survival.
In 445 patients irradiated for bone metastases, radiotherapy regimen plus 13 factors (age, gender, Karnofsky performance score (KPS), primary tumor type, interval between cancer diagnosis and RT of bone metastases, visceral metastases, other (non-irradiated) bone metastases, sites of bone metastases, number of irradiated sites, pathological fracture, fractionation of RT, pre-RT surgery, pre-RT administration of bisphosphonates/denosumab, pre-RT systemic anticancer treatment) were retrospectively analyzed for survival. Factors achieving significance (p < 0.05) or borderline significance (p < 0.055) on multivariate analysis were used for the scoring system. Twelve-month survival rates were divided by 10 (factor scores); factor scores were summed for each patient (patient scores).
On multivariate analysis, survival was significantly associated with KPS (hazard ratio (HR) 1.91, p < 0.001) and primary tumor type (HR 1.12, p < 0.001); age achieved borderline significance (HR 1.14, p = 0.054). These factors were used for the scoring tool. Patient scores ranged from 8 to 17 points. Three groups were designated: 8-9 (A), 10-14 (B) and 15-17 (C) points. Twelve-month survival rates were 9, 38 and 72% (p < 0.001); median survival times were 3, 8 and 24 months.
This new tool developed for patients irradiated for bone metastases at any site without spinal cord compression allows one to predict the survival of these patients and can aid physicians when assigning the treatment to individual patients.
针对骨转移的个体化治疗应考虑患者的剩余寿命。评分工具可帮助预测生存情况。本研究开发了一种新的工具，专门用于估计 12 个月的生存率。
回顾性分析 445 例接受骨转移放疗患者的放疗方案和 13 个因素（年龄、性别、卡氏功能状态评分（KPS）、原发肿瘤类型、癌症诊断与骨转移放疗之间的时间间隔、内脏转移、其他（未放疗）骨转移、骨转移部位、放疗部位数量、病理性骨折、放疗分割、放疗前手术、放疗前双膦酸盐/地舒单抗、放疗前全身抗癌治疗）与生存的关系。多因素分析中具有统计学意义（p < 0.05）或边缘统计学意义（p < 0.055）的因素用于评分系统。将 12 个月生存率除以 10（因子得分）；为每位患者累加因子得分（患者得分）。
多因素分析显示，KPS（风险比（HR）1.91，p < 0.001）和原发肿瘤类型（HR 1.12，p < 0.001）与生存显著相关；年龄具有边缘统计学意义（HR 1.14，p = 0.054）。这些因素用于评分工具。患者得分范围为 8 至 17 分。将患者分为三组：8-9（A）分、10-14（B）分和 15-17（C）分。12 个月生存率分别为 9%、38%和 72%（p < 0.001）；中位生存时间分别为 3、8 和 24 个月。
本研究为无脊髓压迫的任何部位骨转移接受放疗的患者开发了一种新的工具，可预测这些患者的生存情况，并在为患者分配治疗方案时为医生提供帮助。
