Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis

Ratasvuori, Maire; Wedin, Rikard; Keller, Johnny; Nottrott, Markus; Zaikova, Olga; Bergh, Peter; Kalén, Anders; Nilsson, Jan; Jónsson, Halldór; Laitinen, Minna

doi:10.1016/j.suronc.2013.02.008

Cited by 185 publications

(188 citation statements)

References 29 publications

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“…We developed a classic scoring system to estimate survival probability by assigning a weighted score to every factor independently associated with survival by rounding its HR to the nearest integer [2,19,31]. To allow for scoring of continuous variables, we dichotomized age (65 years and older) and hemoglobin level (10 g/dL and less) and rounded the HRs of the mean difference between the dichotomized groups to the nearest integer (mean difference in age, 20 years [HR, 1.34] and mean difference in hemoglobin level 2.6 g/dL [HR, 1.27]) [24].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies developed scoring algorithms to estimate survival [2,8,9,19,24,31], but survival estimates remain imprecise [24]. In an attempt to improve survival estimation, we assessed which clinical factors and laboratory values were independent predictors of survival.…”

Section: Discussionmentioning

confidence: 99%

“…Locate the total points on the total points axis and draw a line straight down to find the 30-, 90-, and 365-day survival probabilities. BMI categories are: (1) Previous studies of patients with metastatic fractures found that visceral metastases, primary tumor type, number of bone metastases, time from diagnosis of primary tumor to surgery for metastatic fracture, fracture type, performance status, previous chemotherapy, and hemoglobin level were independently associated with survival [2,19,24,31,32]. We identified additional factors associated with survival in patients with metastatic fractures, namely, comorbidity status and BMI.…”

Section: Discussionmentioning

confidence: 99%

“…We selected the following explanatory variables based on the existing studies [19,24,31] or theoretical association with survival: age, sex, BMI, comorbidity status, primary tumor type, type of fracture, anatomic location of fracture, time from diagnosis of the primary tumor until operative treatment, other bone metastases, other previous metastatic fractures, visceral metastases, previous systemic therapy, previous local radiotherapy of the affected long bone, and preoperative hemoglobin level, platelet level, white blood cell count, creatinine, and serum calcium level.…”

Section: Methodsmentioning

confidence: 99%

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2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?

Janssen

Heijden

Dijke

et al. 2015

Clin Orthop Relat Res

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Background Survival estimation guides surgical decisionmaking in metastatic bone disease. Traditionally, classic scoring systems, such as the Bauer score, provide survival estimates based on a summary score of prognostic factors. Identification of new factors might improve the accuracy of these models. Additionally, the use of different algorithms-nomograms or boosting algorithms-could further improve accuracy of prognostication relative to classic scoring systems. A nomogram is an extension of a classic scoring system and generates a more-individualized survival probability based on a patient's set of characteristics using a figure. Boosting is a method that automatically trains to classify outcomes by applying classifiers (variables) in a sequential way and subsequently combines them. A boosting algorithm provides survival probabilities based on every possible combination of variables. Questions/purposes We wished to (1) assess factors independently associated with decreased survival in patients with metastatic long bone fractures and (2) compare the accuracy of a classic scoring system, nomogram, and boosting algorithms in predicting 30-, 90-, and 365-day survival. Methods We included all 927 patients in our retrospective study who underwent surgery for a metastatic long bone fracture at two institutions between January 1999 and December 2013. We included only the first procedure if patients underwent multiple surgical procedures or had more than one fracture. Median followup was 8 months (interquartile range, 3-25 months); 369 of 412 (90%) patients who where alive at 1 year were still in followup. Multivariable Cox regression analysis was used to identify One author (SJ) certifies that he has received, an amount less than USD 10,000, from the Anna Foundation (Oegstgeest, The Netherlands), an amount less than USD 10,000 from the De Drie Lichten Foundation (Hilversum, The Netherlands), an amount less than USD 10,000 from the KWF Kankerbestrijding (Amsterdam, The Netherlands), and an amount less than USD 10,000, from the Michael van Vloten Foundation (Rotterdam, The Netherlands). One author (JS) certifies that he or a member of his family has or may receive payments or benefits, an amount less than USD 10,000, from Stryker (Kalamazoo, MI, USA), and an amount less than USD 10,000, from Biom'up (Saint-Priest, Lyon, France). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research. This work was performed at Massachusetts General Hospital, Boston, MA, USA. clinical and laboratory factors independently associated with decreased survival. We created a classic scoring system, nomogram, and boosting algorithms based on identified variables. Accuracy of the algorithms was assessed using area unde...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?

Janssen

Heijden

Dijke

et al. 2015

Clin Orthop Relat Res

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“…A betegek túlélési esélyei azonban metasztázisok esetében is növekedtek. A Skandináv Skeletalis Metasztá-zis Regiszter adatai alapján [2] a rák incidenciája a lakosság körében 18%-kal nőtt az elmúlt évtizedben, azonban a halálozás mindössze 2%-kal, ami a javuló kezelési eredményeknek köszönhető.…”

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Paradigmaváltás a csontmetasztázisok sebészetében. I. Végtagi és medencelokalizációjú áttétek

et al. 2017

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Rákregiszterek statisztikái szerint míg a rák incidenciája az elmúlt évtizedben is folyamatosan nőtt, az újabb hatásos multimodalitású kezelések eredményeképpen a mortalitása alig emelkedett. Összefoglaló közleményünk célja annak bemutatása, hogy újabb irodalmi adatok alapján hogyan változott a csontmetasztázisos betegek túlélése, milyen prognosztikai faktorok befolyásolják a betegek esélyeit. A jobb eredmények aktívabb sebészi beavatkozást eredményeztek a végtagi és a csigolyaáttétek kezelésében egyaránt. Bemutatjuk a sebészi rekonstrukciós eljárások algoritmusát, tár-gyaljuk a különböző megoldások előnyeit, hátrányait, szövődményeit. Megállapítható, hogy a patológiás/fenyegető patológiás törésektől eltekintve nem a sebészi az első körben választandó eljárás, és ez is rendszerint palliatív céllal történik. Célja, hogy a beteg fájdalmait csökkentsük, mobilitását visszaadjuk, életminőségét javítsuk, lehetőleg olyan kevéssé megterhelő eljárásokkal (minimálisan invazív), amelyek gyors rehabilitációt tesznek lehetővé, és a beteg élete végéig kitartanak. Optimális esetben, körülbelül 10-15%-ban, lehetőség van a metasztázis kuratív eltávolítására is, biztatóak a jobb túlélési eredmények. Orv Hetil. 2017; 158(40): 1563-1569.Kulcsszavak: csontmetasztázis, kivizsgálási algoritmus, prognosztikai faktorok, végtag, medence, metasztázis-sebészet Change of paradigm in the surgical treatment of metastatic diseases of bone Part I. Bony metastases of the extremities and pelvisAccording to the statistical data of tumor registries the incidence of cancer has increased in the last decade, however the mortality shows only a slight change due to the new and effective multimodal treatments. The aim of our overview article is to present the changes in the survival of the metastatic patients, and to demonstrate which factors influence their prognosis. The improvement of survival resulted in a more active surgical role both in metastases of the bone of the extremities and the pelvis. We present a diagnostic flow chart and current options for the reconstruction of the different regions of the bone and skeleton, and we will discuss their potential advantages, disadvantages and complications. It is evident that apart from the impending and pathological fracture surgery it is not the first choice of treatment but rather a palliative measure. The aim of surgery is to alleviate pain, to regain mobility and improve quality of life. If possible minimal invasive techniques are performed, as they are less demanding and allow fast rehabilitation for the patient, and they are solutions that last for a lifetime. In optimal conditions radical curative surgery can be performed in about 10 to 15 per cent of the cases, and better survival is encouraging.Keywords: metastatic bone diseases, diagnostic algorhythm, prognostic factors, extremity, pelvis, surgery for metastatic bone diseases

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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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Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis

Cited by 185 publications

References 29 publications

2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?

2015 Marshall Urist Young Investigator Award: Prognostication in Patients With Long Bone Metastases: Does a Boosting Algorithm Improve Survival Estimates?

Paradigmaváltás a csontmetasztázisok sebészetében. I. Végtagi és medencelokalizációjú áttétek

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

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