Shi Xuedong, Cui Yunpeng, Pan Yuanxing, Wang Bing, Lei Mingxing
Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China.
Department of Orthopedic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.
J Bone Oncol. 2021 May 1;28:100365. doi: 10.1016/j.jbo.2021.100365. eCollection 2021 Jun.
To investigate the epidemiology of cement leaks and further develop an algorithm to detect the high risk of cement leaks among advanced cancer patients with metastatic spinal disease treated with percutaneous vertebroplasty.
This study retrospectively analyzed 309 patients with metastatic spinal disease treated with percutaneous vertebroplasty. Patients were randomly divided into a training group and a validation group. In the training group, 13 potential characteristics were analyzed for their abilities to predict cement leaks. Discal cement leakage and paravertebral cement leakage were excluded from the analysis. Those characteristics identified as having significant predictive value were used to develop a predictive algorithm. Internal validation of the algorithm was performed based on discrimination and calibration qualities.
Overall, cement leaks occurred in 61.17% (189/309) patients. Among the 13 characteristics analyzed, younger age (P = 0.03), extravertebral bone metastases (P = 0.02), increased number of treated vertebrae levels (P < 0.01), and cortical osteolytic destruction in the posterior wall (P = 0.01) were included in the algorithm. This algorithm generates a score between 0 and 16 points, with higher scores indicating a higher risk of cement leakage. The area under the receiver operating characteristic curve (AUROC) value for the algorithm was 0.75 in the training group and 0.69 in the validation group. The mean correct classification rates for the training and validation groups were 73.5% and 64.9%, respectively, and the corresponding P-values of the goodness-of-fit test were 0.70 and 0.50.
Cement leaks are common in patients with metastatic spinal disease treated with percutaneous vertebroplasty. The present study proposed and internally validated an algorithm that can be used to screen patients at high risk of cement leakage.
调查骨水泥渗漏的流行病学情况，并进一步开发一种算法，以检测接受经皮椎体成形术治疗的晚期癌症转移性脊柱疾病患者发生骨水泥渗漏的高风险。
本研究回顾性分析了309例接受经皮椎体成形术治疗的转移性脊柱疾病患者。患者被随机分为训练组和验证组。在训练组中，分析了13个潜在特征预测骨水泥渗漏的能力。分析中排除了椎间盘骨水泥渗漏和椎旁骨水泥渗漏。将那些具有显著预测价值的特征用于开发预测算法。基于区分度和校准质量对算法进行内部验证。
总体而言，189例（61.17%）患者发生了骨水泥渗漏。在分析的13个特征中，算法纳入了年龄较小（P = 0.03）、椎体外骨转移（P = 0.02）、治疗椎体节段数量增加（P < 0.01）以及后壁皮质骨溶解性破坏（P = 0.01）。该算法生成的分数在0至16分之间，分数越高表明骨水泥渗漏风险越高。该算法在训练组中的受试者工作特征曲线（AUROC）下面积值为0.75，在验证组中为0.69。训练组和验证组的平均正确分类率分别为73.5%和64.9%，拟合优度检验的相应P值分别为0.70和0.50。
经皮椎体成形术治疗的转移性脊柱疾病患者中骨水泥渗漏很常见。本研究提出并内部验证了一种可用于筛查骨水泥渗漏高风险患者的算法。
