External Validation and Optimization of the SPRING Model for Prediction of Survival After Surgical Treatment of Bone Metastases of the Extremities

Sørensen, Michala Skovlund; Gerds, Thomas Alexander; Hindsø, Klaus; Petersen, Michael Mørk

doi:10.1097/01.blo.0000534678.44152.ee

Cited by 26 publications

(57 citation statements)

References 21 publications

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“…The presence of a pre-operative pathological fracture was not associated with survival in our independent femoral patient cohort. The SPRING nomogram and PathFx model include the presence of a pre-operative pathological fracture in their assessment of survival for the patient yet the other models do not utilise it for survival estimation [14], [16]. Further work and a meta-analysis may be required to investigate the value of this prognostic variable.…”

Section: Discussionmentioning

confidence: 99%

“…However, all prognostic models except OPTIModel included multiple myeloma and lymphoma it the assessment of patient survival. These haematological malignancies cause pathological fractures of the femur requiring orthopaedic management [3], [13], [14], [15], [16], [35], [36]. This analysis included multiple myeloma and lymphoma primary cancer types in the femoral MBD patient dataset.…”

Section: Discussionmentioning

confidence: 99%

“…All patients were assessed using six scoring systems for appendicular MBD. The prognostic models included the revised Katagiri model, PathFx model, Ratasvuori SSG scale, Janssen nomogram, OPTIModel and SPRING 13 nomogram [3], [13], [14], [15], [16], [17]. These estimated prognoses were calculated using the retrospective data for each patient at the time of operative management.…”

Section: Methodsmentioning

confidence: 99%

“…Expected survival is the most important factor to determine the treatment modality. In order to assess the survival time after occurrence of appendicular metastases, pre-operative prognosis models have been devised by Katagiri et al, Forsberg et al (referred to as the PathFx model), Ratasvuori et al (Scandinavian Sarcoma Group – SSG), Janssen et al, Willeumier et al (referred to as the OPTIModel model) and Sorensen et al (referred to as the SPRING model) [3], [13], [14], [15], [16], [17]. Currently, there is no consensus regarding which prognostic model is the most accurate.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of survival after surgical management of femoral metastatic bone disease – A comparison of prognostic models

Meares

Badran²,

Dewar

2019

Journal of Bone Oncology

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Background Operative fixation for femoral metastatic bone disease is based on the principles of reducing pain and restoring function. Recent literature has proposed a number of prognostic models for appendicular metastatic bone disease. The aim of this study was to compare the accuracy of proposed soring systems in the setting of femoral metastatic bone disease in order to provide surgeons with information to determine the most appropriate scoring system in this setting. Methods A retrospective cohort analysis of patients who underwent surgical management of femoral metastatic bone disease at a single institution were included. A pre-operative predicted survival for all 114 patients was retrospectively calculated utilising the revised Katagiri model, PathFx model, SSG score, Janssen nomogram, OPTModel and SPRING 13 nomogram. Univariate and multivariate Cox regression proportional hazard models were constructed to assess the role of prognostic variables in the patient group. Area under the receiver characteristics and Brier scores were calculated for each prognostic model from comparison of predicted survival and actual survival of patients to quantify the accuracy of each model. Results For the femoral metastatic bone disease patients treated with surgical fixation, multivariate analysis demonstrated a number of pre-operative factors associated with survival in femoral metastatic bone disease, consistent with established literature. The OPTIModel demonstrated the highest accuracy at predicting 12-month (Area Under the Curve [AUC] = 0.79) and 24-month (AUC = 0.77) survival after surgical management. PathFx model was the most accurate at predicting 3-month survival (AUC = 0.70) and 6-month (AUC = 0.70) survival. The PathFx model was successfully externally validated in the femoral patient dataset for all time periods. Conclusions Among six prognostic models assessed in the setting of femoral metastatic bone disease, the present study observed the most accurate model for 3-month, 6-month, 12-month and 24-month survival. The results of this study may be utilised by the treating surgical team to determine the most accurate model for the required time period and therefore improve decision-making in the care of patients with femoral metastatic bone disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prediction of survival after surgical management of femoral metastatic bone disease – A comparison of prognostic models

Meares

Badran²,

Dewar

2019

Journal of Bone Oncology

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“…Estimating survival and correlating choice of implant to survival estimates, prevents too extensive surgery and rehabilitation in patients with short survival and an unacceptably high implant failure rate in those who live longer. As externally validated survival models that are free to use exist, there are no reasons not to do so[ 28 - 31 , 32 ]. There are generally three treatment strategies: Osteosynthesis, prosthetic reconstruction or local excision with or without reconstruction ( i.e ., curettage with or without cementation, cementoplasty, excision arthroplasty, resection of a bone segment or amputation).…”

Section: Methods and Outcome Of Surgical Treatmentmentioning

confidence: 99%

Current concepts in the surgical treatment of skeletal metastases

Ehne

Tsagozis

2020

WJO

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Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients’ quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.

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Comparison of eight modern preoperative scoring systems for survival prediction in patients with extremity metastasis

et al. 2023

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Background: Survival is an important factor to consider when clinicians make treatment decisions for patients with skeletal metastasis. Several preoperative scoring systems (PSSs) have been developed to aid in survival prediction. Although we previously validated the Skeletal Oncology Research Group Machine-learning Algorithm (SORG-MLA) in Taiwanese patients of Han Chinese descent, the performance of other existing PSSs remains largely unknown outside their respective development cohorts. We aim to determine which PSS performs best in this unique population and provide a direct comparison between these models. Methods:We retrospectively included 356 patients undergoing surgical treatment for extremity metastasis at a tertiary center in Taiwan to validate and compare eight PSSs. Discrimination (c-index), decision curve (DCA), calibration (ratio of observed:expected survivors), and overall performance (Brier score) analyses were conducted to evaluate these models' performance in our cohort. Results:The discriminatory ability of all PSSs declined in our Taiwanese cohort compared with their Western validations. SORG-MLA is the only PSS that still demonstrated excellent discrimination (c-indexes>0.8) in our patients. SORG-MLA also brought the most net benefit across a wide range of risk probabilities on DCA with its 3-month and 12-month survival predictions.Conclusions: Clinicians should consider potential ethnogeographic variations of a PSS's performance when applying it onto their specific patient populations.Further international validation studies are needed to ensure that existing PSSs are generalizable and can be integrated into the shared treatment decision-making | 14265 LEE et al.

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External Validation and Optimization of the SPRING Model for Prediction of Survival After Surgical Treatment of Bone Metastases of the Extremities

Abstract: Level I, diagnostic study.

Cited by 26 publications

References 21 publications

Prediction of survival after surgical management of femoral metastatic bone disease – A comparison of prognostic models

Prediction of survival after surgical management of femoral metastatic bone disease – A comparison of prognostic models

Current concepts in the surgical treatment of skeletal metastases

Comparison of eight modern preoperative scoring systems for survival prediction in patients with extremity metastasis

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