Smolle Maria Anna, Musser Ewald, Bergovec Marko, Friesenbichler Joerg, Wibmer Christine Linda, Leitner Lukas, Sørensen Michala Skovlund, Petersen Michael Mørk, Brcic Iva, Szkandera Joanna, Scheipl Susanne, Leithner Andreas
Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria.
Department of Orthopaedic Surgery, Rigshospitalet, University Hospital of Copenhagen, 2100 Copenhagen, Denmark.
Cancers (Basel). 2022 Jul 20;14(14):3521. doi: 10.3390/cancers14143521.
The aim of this study was to externally validate the 2013-SPRING model, a survival prediction tool for patients treated surgically for bone metastases in a retrospective patient cohort from a single institution. Moreover, subgroup analyses on patients treated with (A) endoprostheses or (B) osteosynthesis, as well as (C) upper limb and (D) lower limb metastases, were performed.
Altogether, 303 cancer patients (mean age: 67.6 ± 11.1 years; 140 males (46.2%)) with bone metastases to the extremities, treated surgically between March 2000 and June 2018 at a single tertiary sarcoma centre, were retrospectively included. Median follow-up amounted to 6.3 (interquartile range (IQR): 2.3-21.8) months, with all patients followed-up for at least one year or until death. The 2013-SPRING model was applied to assess the prognostication accuracy at 3, 6 and 12 months. Models were validated with area under the curve receiver operator characteristic (AUC ROC; the higher the better), as well as Brier score.
Of the 303 patients, 141 had been treated with osteosynthesis (46.5%), and the remaining 162 patients with endoprosthesis (53.5%). Sixty-five (21.5%) metastases were located in the upper limbs, and two hundred and thirty-eight (78.5%) in the lower limbs. Using the 2013-SPRING model for the entire cohort, the accuracy of risk of death prediction at 3, 6 and 12 months, determined by the AUC ROC, was 0.782 (95% CI: 0.729-0.843), 0.810 (95% CI: 0.763-0.858) and 0.802 (95% CI: 0.751-0.854), respectively. Corresponding Brier scores were 0.170, 0.178 and 0.169 at 3, 6 and 12 months. In the subgroup analyses, predictive accuracy of the 2013-SPRING model was likewise encouraging, albeit being slightly higher in the osteosynthesis subgroup as compared with the endoprosthesis subgroup, and also higher in the upper limb in comparison to the lower limb metastasis subgroup.
The current validation study of the 2013-SPRING model shows that this model is clinically relevant to use in an external cohort, also after stratification for surgical procedure and metastasis location.
本研究旨在对2013 - SPRING模型进行外部验证，该模型是一种用于预测在单一机构接受手术治疗的骨转移患者生存率的工具。此外，还对接受（A）假体植入或（B）骨固定治疗的患者，以及（C）上肢和（D）下肢骨转移患者进行了亚组分析。
回顾性纳入2000年3月至2018年6月期间在一家三级肉瘤中心接受手术治疗的303例四肢骨转移癌患者（平均年龄：67.6±11.1岁；男性140例（46.2%））。中位随访时间为6.3（四分位间距（IQR）：2.3 - 21.8）个月，所有患者均随访至少一年或直至死亡。应用2013 - SPRING模型评估3、6和12个月时的预后预测准确性。通过曲线下面积接受者操作特征（AUC ROC；越高越好）以及Brier评分对模型进行验证。
303例患者中，141例接受了骨固定治疗（46.5%），其余162例接受了假体植入治疗（53.5%）。65例（21.5%）骨转移位于上肢，238例（78.5%）位于下肢。对于整个队列使用2013 - SPRING模型，由AUC ROC确定的3、6和12个月时死亡风险预测的准确性分别为0.782（95%CI：0.729 - 0.843）、0.810（95%CI：0.763 - 0.858）和0.802（95%CI：0.751 - 0.854）。3、6和12个月时相应的Brier评分分别为0.170、0.178和0.169。在亚组分析中，2013 - SPRING模型的预测准确性同样令人鼓舞，尽管骨固定亚组的预测准确性略高于假体植入亚组，上肢骨转移亚组的预测准确性也高于下肢骨转移亚组。
当前对2013 - SPRING模型的验证研究表明，该模型在外部队列中具有临床应用价值，在按手术方式和转移部位分层后也是如此。
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