Nater Anick, Chuang Junior, Liu Kuan, Quraishi Nasir A, Pasku Dritan, Wilson Jefferson R, Fehlings Michael G
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2020 Aug;140:654-663.e13. doi: 10.1016/j.wneu.2020.03.098.
Surgery should be considered for patients with metastatic epidural spinal cord compression (MESCC) with a life expectancy of ≥3 months. Given the heterogeneity of the clinical presentation and outcomes, clinical prognostic models (CPMs) can assist in tailoring a personalized medicine approach to optimize surgical decision-making. We aimed to develop and internally validate the first CPM of health-related quality of life (HRQoL) and a novel CPM to predict the survival of patients with MESCC treated surgically. Using data from 258 patients (AOSpine North America MESCC study and Nottingham MESCC registry), we created 1-year survival and HRQoL CPMs using a Cox model and logistic regression analysis with manual backward elimination. The outcome measure for HRQoL was the minimal clinical important difference in EuroQol 5-dimension questionnaire scores. Internal validation involved 200 bootstrap iterations, and calibration and discrimination were evaluated. Longer survival was associated with a higher SF-36 physical component score (hazard ratio [HR], 0.96). In contrast, primary tumor other than breast, thyroid, or prostate (unfavorable: HR, 2.57; other: HR, 1.20), organ metastasis (HR, 1.51), male sex (HR, 1.58), and preoperative radiotherapy (HR, 1.53) were not (c-statistic, 0.69; 95% confidence interval, 0.64-0.73). Karnofsky performance status <70% (odds ratio [OR], 2.50), living in North America (OR, 4.06), SF-36 physical component score (OR, 0.95) and SF-36 mental component score (OR, 0.96) were associated with the likelihood of achieving a minimal clinical important difference improvement in the EuroQol 5-Dimension Questionnaire score at 3 months (c-statistic, 0.74; 95% confidence interval, 0.68-0.79). The calibration for both CPMs was very good. We developed and internally validated the first CPMs of survival and HRQoL at 3 months postoperatively in patients with MESCC using the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) guidelines. A web-based calculator is available (available at: http://spine-met.com) to assist with clinical decision-making.
预期寿命≥3个月的转移性硬膜外脊髓压迫（MESCC）患者应考虑手术治疗。鉴于临床表现和预后的异质性，临床预后模型（CPM）有助于制定个性化医疗方法，以优化手术决策。我们旨在开发并内部验证首个健康相关生活质量（HRQoL）的CPM以及一种新型CPM，以预测接受手术治疗的MESCC患者的生存情况。利用来自258例患者的数据（北美脊柱外科学会MESCC研究和诺丁汉MESCC登记处），我们使用Cox模型和逻辑回归分析并通过手动向后消除法创建了1年生存率和HRQoL的CPM。HRQoL的结局指标是欧洲五维健康量表（EuroQol 5-dimension questionnaire）得分的最小临床重要差异。内部验证涉及200次自抽样迭代，并评估了校准和区分度。更长的生存期与更高的SF-36身体成分得分相关（风险比[HR]，0.96）。相比之下，非乳腺、甲状腺或前列腺的原发性肿瘤（不利情况：HR，2.57；其他情况：HR，1.20）、器官转移（HR，1.51）、男性（HR，1.58）和术前放疗（HR，1.53）则不然（c统计量，0.69；95%置信区间，0.64-0.73）。卡氏功能状态<70%（比值比[OR]，2.50）、居住在北美（OR，4.06）、SF-36身体成分得分（OR，0.95）和SF-36精神成分得分（OR, 0.96）与3个月时欧洲五维健康量表得分实现最小临床重要差异改善的可能性相关（c统计量，0.74；95%置信区间，0.68-0.79）。两种CPM的校准效果都非常好。我们使用TRIPOD（个体预后或诊断多变量预测模型透明报告）指南，开发并内部验证了MESCC患者术后3个月生存和HRQoL的首个CPM。现有一个基于网络的计算器（可在http://spine-met.com获取）来协助临床决策。
