Smolle Maria A, Elmer Philip, Wenzl Florian A, Leitner Lukas, Ferlic Peter, Scheipl Susanne, Sadoghi Patrick, Leithner Andreas
Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952, Schlieren, Switzerland.
J Orthop Surg Res. 2025 Aug 11;20(1):754. doi: 10.1186/s13018-025-06147-7.
We aimed to 1) assess the prognostic performance of established prediction models for mortality in patients with spine and extremity bone metastases, 2) evaluate their performance in clinically relevant subgroups, and 3) study the importance of relevant patient characteristics for mortality prediction.
Between 29th May, 2000 and 21st April, 2022, a total of 526 patients (median age 67.0 years, interquartile range [IQR] 58.1 - 74.0 years], 271 males; median follow-up 267 days [IQR 86 - 856 days]) undergoing surgery for spine or extremity bone metastases were retrospectively included. Nine prognostic models were evaluated in the entire cohort (n = 526), and separately in subgroups treated for spine (n = 224) or extremity (n = 302) metastases. Cox-regression and logistic regression models were used, as appropriate. Harrell's c-statistic, the area under the receiver operating characteristic curve (AUC ROC) and Brier score were used as performance metrics.
When assessed in the entire cohort, models by Sorensen et al. (AUC 12 months 0.834), Janssen et al. (c-index 0.711) and Katagiri et al. (c-index 0.699) achieved highest discriminatory performance. Likewise, all three models performed best when studied in the spine subgroup (Sorensen et al.: AUC 12 months 0.826; Janssen et al.: c-index 0.723; Katagiri et al.: c-index 0.717), although the models by Sorensen et al. and Janssen et al. had been developed for patients with extremity metastasis. Performance of all models was slightly lower when assessed in the extremity subgroup. Haemoglobin levels and tumour profile (i.e. primary histology) ranked among the most important predictors, consistent across subgroups.
Our study suggests particularly helpful predictive performance of the models by Sorensen et al. and Janssen et al. in both patients with extremity metastases and patients with spine metastases undergoing surgery. Given that we only included patients undergoing surgery, additional validation studies in conservatively treated patients are warranted.
我们旨在:1)评估已建立的脊柱和四肢骨转移患者死亡率预测模型的预后性能;2)评估其在临床相关亚组中的性能;3)研究相关患者特征对死亡率预测的重要性。
回顾性纳入2000年5月29日至2022年4月21日期间共526例接受脊柱或四肢骨转移手术的患者(中位年龄67.0岁,四分位间距[IQR]58.1 - 74.0岁,男性271例;中位随访267天[IQR 86 - 856天])。在整个队列(n = 526)中评估了9种预后模型,并分别在接受脊柱转移治疗的亚组(n = 224)或四肢转移治疗的亚组(n = 302)中进行评估。酌情使用Cox回归和逻辑回归模型。使用Harrell氏c统计量、受试者操作特征曲线下面积(AUC ROC)和Brier评分作为性能指标。
在整个队列中评估时,Sorensen等人的模型(12个月时AUC为0.834)、Janssen等人的模型(c指数为0.711)和Katagiri等人的模型(c指数为0.699)具有最高的鉴别性能。同样,在脊柱亚组中研究时,这三种模型表现最佳(Sorensen等人:12个月时AUC为0.826;Janssen等人:c指数为0.723;Katagiri等人:c指数为0.717),尽管Sorensen等人和Janssen等人的模型是针对四肢转移患者开发的。在四肢亚组中评估时,所有模型的性能略低。血红蛋白水平和肿瘤特征(即原发组织学)是最重要的预测因素之一,各亚组情况一致。
我们的研究表明,Sorensen等人和Janssen等人的模型在接受手术的四肢转移患者和脊柱转移患者中均具有特别有用的预测性能。鉴于我们仅纳入了接受手术的患者,有必要在接受保守治疗的患者中进行额外的验证研究。