Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA.
Spine J. 2022 Dec;22(12):2033-2041. doi: 10.1016/j.spinee.2022.07.089. Epub 2022 Jul 14.
Historically, spine surgeons used expected postoperative survival of 3-months to help select candidates for operative intervention in spinal metastasis. However, this cutoff has been challenged by the development of minimally invasive techniques, novel biologics, and advanced radiotherapy. Recent studies have suggested that a life expectancy of 6 weeks may be enough to achieve significant improvements in postoperative health-related quality of life.
The purpose of this study was to develop a model capable of predicting 6-week mortality in patients with spinal metastases treated with radiation or surgery.
STUDY DESIGN/SETTING: A retrospective review was conducted at five large tertiary centers in the United States and Taiwan.
The development cohort consisted of 3,001 patients undergoing radiotherapy and/or surgery for spinal metastases from one institution. The validation institutional cohort consisted of 1,303 patients from four independent, external institutions.
The primary outcome was 6-week mortality.
Five models were considered to predict 6-week mortality, and the model with the best performance across discrimination, calibration, decision-curve analysis, and overall performance was integrated into an open access web-based application.
The most important variables for prediction of 6-week mortality were albumin, primary tumor histology, absolute lymphocyte, three or more spine metastasis, and ECOG score. The elastic-net penalized logistic model was chosen as the best performing model with AUC 0.84 on evaluation in the independent testing set. On external validation in the 1,303 patients from the four independent institutions, the model retained good discriminative ability with an area under the curve of 0.81. The model is available here: https://sorg-apps.shinyapps.io/spinemetssurvival/.
While this study does not advocate for the use of a 6-week life expectancy as criteria for considering operative management, the algorithm developed and externally validated in this study may be helpful for preoperative planning, multidisciplinary management, and shared decision-making in spinal metastasis patients with shorter life expectancy.
历史上，脊柱外科医生使用术后 3 个月的预期生存率来帮助选择脊柱转移瘤手术干预的候选者。然而，微创技术、新型生物制剂和先进的放疗技术的发展对这一标准提出了挑战。最近的研究表明，6 周的预期寿命可能足以显著提高术后健康相关生活质量。
本研究旨在建立一个能够预测接受放疗或手术治疗的脊柱转移瘤患者 6 周死亡率的模型。
研究设计/设置：回顾性研究在美国和台湾的五家大型三级中心进行。
开发队列由一家机构的 3001 例接受放疗和/或手术治疗的脊柱转移瘤患者组成。验证机构队列由来自四个独立外部机构的 1303 例患者组成。
6 周死亡率。
考虑了 5 种模型来预测 6 周死亡率，具有最佳区分度、校准度、决策曲线分析和整体性能的模型被整合到一个开放访问的网络应用程序中。
预测 6 周死亡率的最重要变量是白蛋白、原发肿瘤组织学、绝对淋巴细胞计数、3 个或更多脊柱转移灶和 ECOG 评分。弹性网络惩罚逻辑回归模型被选为表现最佳的模型，在独立测试集中的 AUC 为 0.84。在来自四个独立机构的 1303 例患者的外部验证中，该模型保持了良好的判别能力，曲线下面积为 0.81。该模型可在此处获得：https://sorg-apps.shinyapps.io/spinemetssurvival/。
虽然本研究不主张将 6 周预期寿命作为考虑手术治疗的标准，但本研究中开发和外部验证的算法可能有助于脊柱转移瘤患者的术前规划、多学科管理和基于预期寿命的共享决策。
