TY - JOUR
T1 - A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management
AU - Choi, David
AU - Pavlou, Menelaos
AU - Omar, Rumana
AU - Arts, Mark
AU - Balabaud, Laurent
AU - Buchowski, Jacob Maciej
AU - Bunger, Cody
AU - Chung, Chun Kee
AU - Coppes, Maarten Hubert
AU - Depreitere, Bart
AU - Fehlings, Michael George
AU - Kawahara, Norio
AU - Lee, Chong Suh
AU - Leung, Yee Ling
AU - Martin-Benlloch, Juan Antonio
AU - Massicotte, Eric Maurice
AU - Mazel, Christian
AU - Meyer, Bernhard
AU - Oner, Fetullah Cumhur
AU - Peul, Wilco
AU - Quraishi, Nasir
AU - Tokuhashi, Yasuaki
AU - Tomita, Katsuro
AU - Ulbricht, Christian
AU - Verlaan, Jorrit Jan
AU - Wang, Michael
AU - Crockard, Hugh Alan
N1 - Funding Information:
This work was carried out in part at University College London Hospitals, which received funding from the Department of Health (UK) National Institute for Health Research , Biomedical Research Centre. Funding was also provided by the Global Spine Tumour Study Group (Registered charity 1134934 , Charities Commission of England and Wales) and DePuy Spine (Johnson and Johnson) .
Funding Information:
Dr. Buchowski reports grants and non-financial support from AO Spine North America , grants and non-financial support from OMeGA , other support from Globus Medical , other support from Medtronic , other support from Globus Medical , other support from Orthofix , outside the submitted work. In addition, Dr. Buchowski has a patent Globus Medical issued, a patent K2M issued and a patent Wolters Kluwer Health with royalties paid.
Funding Information:
This work was carried out in part at University College London Hospitals, which received funding from the Department of Health (UK) National Institute for Health Research, Biomedical Research Centre. Funding was also provided by the Global Spine Tumour Study Group (Registered charity 1134934, Charities Commission of England and Wales) and DePuy Spine (Johnson and Johnson).
Funding Information:
Dr. Wang reports grants from Department of Defence, other support from DePuy Spine , Aesculap Spine , JoiMax , K2M , other support from Innovative Surgical Devices, Spinicity, other support from Children's Hospital of Los Angeles, DePuy Spine, Springer Publishing, Quality Medical Publishing, outside the submitted work; In addition, Dr. Wang has a patent Children’s Hospital of LA issued, a patent DePuy Spine issued, a patent Springer Publishing issued and a patent Quality Medical Publishing issued, and Dr. Wang holds stocks in Innovative Surgical Devices and Spinicity. He also holds a consulting role with DePuy Spine, AesculapSpine, Jointax and K2M.
Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2019/1
Y1 - 2019/1
N2 - Aim: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate. We designed a risk calculator to estimate survival after surgery, to inform clinicians and patients when making management decisions. Methods: A prospective cohort study was performed, including 1430 patients with spinal metastases who underwent surgery. Of them, 1264 patients from 20 centres were used for model development using a Cox frailty model. Calibration slope, D-statistic and C-index were used for model validation based on 166 patients. Follow-up was to death or minimum of 2 years after surgery. Pre-operative indices (examination findings, pain, Karnofsky physical functioning score, and radiology) were assessed. Results: An algorithm to predict survival was constructed including the tumour type, ambulatory status, analgesic use, American Society of Anesthesiologists score, number of spinal metastases, previous radiotherapy or chemotherapy, presence of visceral metastases, cervical or thoracic spine involvement, as predictors. An Internet-based risk calculator was developed based on this algorithm, with similar or improved accuracy compared to other validated prognostic scoring systems (C-index, 0.68; 95% confidence interval, 0.63––0.73, and calibration slope, 1.00; 95% confidence interval, 0.68––1.32). Conclusion: A large, prospective, surgical series of patients with symptomatic spinal metastases was used to create a validated risk calculator that can help clinicians to inform patients about the most appropriate treatment plan. The calculator is available at www.spinemet.com.
AB - Aim: Surgery for spinal metastases can improve symptoms, but sometimes complications can negate the benefits. Operations may have different indications, complexities and risks, and the choice for an individual is a tailor-made personalised decision. Previous prognostic scoring systems are becoming out of date and inaccurate. We designed a risk calculator to estimate survival after surgery, to inform clinicians and patients when making management decisions. Methods: A prospective cohort study was performed, including 1430 patients with spinal metastases who underwent surgery. Of them, 1264 patients from 20 centres were used for model development using a Cox frailty model. Calibration slope, D-statistic and C-index were used for model validation based on 166 patients. Follow-up was to death or minimum of 2 years after surgery. Pre-operative indices (examination findings, pain, Karnofsky physical functioning score, and radiology) were assessed. Results: An algorithm to predict survival was constructed including the tumour type, ambulatory status, analgesic use, American Society of Anesthesiologists score, number of spinal metastases, previous radiotherapy or chemotherapy, presence of visceral metastases, cervical or thoracic spine involvement, as predictors. An Internet-based risk calculator was developed based on this algorithm, with similar or improved accuracy compared to other validated prognostic scoring systems (C-index, 0.68; 95% confidence interval, 0.63––0.73, and calibration slope, 1.00; 95% confidence interval, 0.68––1.32). Conclusion: A large, prospective, surgical series of patients with symptomatic spinal metastases was used to create a validated risk calculator that can help clinicians to inform patients about the most appropriate treatment plan. The calculator is available at www.spinemet.com.
KW - Metastasis
KW - Outcome
KW - Risk
KW - Spine surgery
KW - Survival
KW - Tumour
UR - http://www.scopus.com/inward/record.url?scp=85057618084&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2018.11.011
DO - 10.1016/j.ejca.2018.11.011
M3 - Article
C2 - 30529900
AN - SCOPUS:85057618084
SN - 0959-8049
VL - 107
SP - 28
EP - 36
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -