12种现有脊柱转移瘤患者生存预测模型的外部验证

External validation of 12 existing survival prediction models for patients with spinal metastases.

作者信息

Bindels B J J, Kuijten R H, Groot O Q, Huele E H, Gal R, de Groot M C H, van der Velden J M, Delawi D, Schwab J H, Verkooijen H M, Verlaan J J, Tobert D, Rutges J P H J

机构信息

Department of Orthopedic Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Utrecht, The Netherlands.

Division of Imaging and Oncology, Utrecht University, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, Utrecht, The Netherlands.

出版信息

Spine J. 2025 Jul;25(7):1347-1359. doi: 10.1016/j.spinee.2025.01.014. Epub 2025 Jan 31.

DOI:10.1016/j.spinee.2025.01.014

PMID:39894281

Abstract

BACKGROUND CONTEXT

Survival prediction models for patients with spinal metastases may inform patients and clinicians in shared decision-making.

PURPOSE

To externally validate all existing survival prediction models for patients with spinal metastases.

DESIGN

Prospective cohort study using retrospective data.

PATIENT SAMPLE

A total of 953 patients.

OUTCOME MEASURES

Survival in months, area under the curve (AUC), and calibration intercept and slope.

METHOD

This study included patients with spinal metastases referred to a single tertiary referral center between 2016 and 2021. Twelve models for predicting 3, 6, and 12-month survival were externally validated Bollen, Mizumoto, Modified Bauer, New England Spinal Metastasis Score, Original Bauer, Oswestry Spinal Risk Index (OSRI), PathFx, Revised Katagiri, Revised Tokuhashi, Skeletal Oncology Research Group Machine Learning Algorithm (SORG-MLA), Tomita, and Van der Linden. Discrimination was assessed using (AUC) and calibration using the intercept and slope. Calibration was considered appropriate if calibration measures were close to their ideal values with narrow confidence intervals.

RESULTS

In total, 953 patients were included. Survival was 76.4% at 3 months (728/953), 62.2% at 6 months (593/953), and 50.3% at 12 months (479/953). Revised Katagiri yielded AUCs of 0.79 (95% CI, 0.76-0.82) to 0.81 (95% CI, 0.79-0.84), Bollen yielded AUCs of 0.76 (95% CI, 0.73-0.80) to 0.77 (95% CI, 0.75-0.80), and OSRI yielded AUCs of 0.75 (95% CI, 0.72-0.78) to 0.77 (95% CI, 0.74-0.79). The other 9 prediction models yielded AUCs ranging from 0.59 (95% CI, 0.55-0.63) to 0.76 (95% CI, 0.74-0.79). None of the 12 models yielded appropriate calibration.

CONCLUSIONS

Twelve survival prediction models for patients with spinal metastases yielded poor to fair discrimination and poor calibration. Survival prediction models may inform decision-making in patients with spinal metastases, provided that recalibration using recent patient data is performed.

摘要

背景

脊柱转移瘤患者的生存预测模型可为患者和临床医生的共同决策提供参考。

目的

对外验证所有现有的脊柱转移瘤患者生存预测模型。

设计

使用回顾性数据的前瞻性队列研究。

患者样本

共953例患者。

观察指标

以月为单位的生存情况、曲线下面积（AUC）以及校准截距和斜率。

方法

本研究纳入了2016年至2021年间转诊至单一三级转诊中心的脊柱转移瘤患者。对预测3个月、6个月和12个月生存情况的12种模型进行了外部验证，包括博伦模型、水本模型、改良鲍尔模型、新英格兰脊柱转移瘤评分、原始鲍尔模型、奥斯韦斯特里脊柱风险指数（OSRI）、PathFx模型、修订版片桐模型、修订版德桥模型、骨肿瘤研究组机器学习算法（SORG-MLA）、富田模型和范德林登模型。使用（AUC）评估区分度，使用截距和斜率评估校准情况。如果校准指标接近其理想值且置信区间狭窄，则认为校准是合适的。

结果

总共纳入953例患者。3个月时生存率为76.4%（728/953），6个月时为62.2%（593/953），12个月时为50.3%（479/953）。修订版片桐模型的AUC为0.79（95%CI，0.76 - 0.82）至0.81（95%CI，0.79 - 0.84），博伦模型的AUC为0.76（95%CI，0.73 - 0.80）至0.77（95%CI，0.75 - 0.80），OSRI模型的AUC为0.75（95%CI，0.72 - 0.78）至0.77（95%CI，0.74 - 0.79）。其他9种预测模型的AUC范围为0.59（95%CI，0.55 - 0.63）至0.76（95%CI，0.74 - 0.79）。12种模型均未产生合适的校准结果。