Wick Joseph B, Kalistratova Venina S, Jr Dagoberto Piña, Fine Jeffrey R, Boozé Zachary L, Holland Joseph, Vander Voort Wyatt, Hisatomi Lauren A, Villegas Alex, Conry Keegan, Ortega Brandon, Javidan Yashar, Roberto Rolando F, Klineberg Eric O, Le Hai V
Department of Orthopedic Surgery, University of California, Davis, Sacramento, CA.
University of California, Davis, School of Medicine, Sacramento, CA.
Spine (Phila Pa 1976). 2023 Apr 15;48(8):567-576. doi: 10.1097/BRS.0000000000004600. Epub 2023 Feb 15.
Retrospective cohort.
Compare the performance of and provide cutoff values for commonly used prognostic models for spinal metastases, including Revised Tokuhashi, Tomita, Modified Bauer, New England Spinal Metastases Score (NESMS), and Skeletal Oncology Research Group model, at three- and six-month postoperative time points.
Surgery may be recommended for patients with spinal metastases causing fracture, instability, pain, and/or neurological compromise. However, patients with less than three to six months of projected survival are less likely to benefit from surgery. Prognostic models have been developed to help determine prognosis and surgical candidacy. Yet, there is a lack of data directly comparing the performance of these models at clinically relevant time points or providing clinically applicable cutoff values for the models.
Sixty-four patients undergoing surgery from 2015 to 2022 for spinal metastatic disease were identified. Revised Tokuhashi, Tomita, Modified Bauer, NESMS, and Skeletal Oncology Research Group were calculated for each patient. Model calibration and discrimination for predicting survival at three months, six months, and final follow-up were evaluated using the Brier score and Uno's C, respectively. Hazard ratios for survival were calculated for the models. The Contral and O'Quigley method was utilized to identify cutoff values for the models discriminating between survival and nonsurvival at three months, six months, and final follow-up.
Each of the models demonstrated similar performance in predicting survival at three months, six months, and final follow-up. Cutoff scores that best differentiated patients likely to survive beyond three months included the Revised Tokuhashi score=10, Tomita score=four, Modified Bauer score=three, and NESMS=one.
We found comparable efficacy among the models in predicting survival at clinically relevant time points. Cutoff values provided herein may assist surgeons and patients when deciding whether to pursue surgery for spinal metastatic disease.
回顾性队列研究。
比较常用脊柱转移瘤预后模型（包括修订的Tokuhashi模型、Tomita模型、改良的Bauer模型、新英格兰脊柱转移瘤评分（NESMS）和骨骼肿瘤研究组模型）在术后三个月和六个月时间点的表现，并提供截断值。
对于因脊柱转移瘤导致骨折、不稳定、疼痛和/或神经功能损害的患者，可能会建议进行手术。然而，预计生存期不足三到六个月的患者从手术中获益的可能性较小。已经开发了预后模型来帮助确定预后和手术候选资格。然而，缺乏直接比较这些模型在临床相关时间点表现的数据，也缺乏为这些模型提供临床适用截断值的数据。
确定了2015年至2022年期间因脊柱转移性疾病接受手术的64例患者。为每位患者计算修订的Tokuhashi模型、Tomita模型、改良的Bauer模型、NESMS和骨骼肿瘤研究组模型。分别使用Brier评分和Uno's C评估模型在预测三个月、六个月和最终随访时生存情况的校准和区分能力。计算模型的生存风险比。采用Contral和O'Quigley方法确定模型在三个月、六个月和最终随访时区分生存和非生存的截断值。
每个模型在预测三个月、六个月和最终随访时的生存情况方面表现相似。最能区分可能存活超过三个月患者的截断分数包括：修订的Tokuhashi评分为10分，Tomita评分为4分，改良的Bauer评分为3分，NESMS为1分。
我们发现这些模型在预测临床相关时间点的生存情况方面疗效相当。本文提供的截断值可能有助于外科医生和患者决定是否对脊柱转移性疾病进行手术。
4级。
