Several preoperation prognosis models used on the treatment of metastatic bone disease on appendicular skeleton have been devised. The purpose of this study was to compare the performance of different survival prognostic models on patients with metastatic bone disease in long bones in a Chilean population.
This is a multicentric retrospective study. We retrospectively reviewed the medical records of 136 patients who were confirmed with metastatic bone disease of the appendicular skeleton and who were treated surgically from 2016 to 2019. The minimum follow-up time was 12 months. All patients were assessed using four appendicular metastatic bone disease scoring systems. A preoperative predicted survival time for all 136 patients was retrospectively calculated making use of the revised Katagiri, PathFx, Optimodel and IOR score model.
The PathFx model demonstrated an accuracy at predicting 3 (area under the curve [AUC] = 0.61) and 6-month (AUC = 0.65) survival time after surgical management. IOR score model demonstrated an accuracy at predicting 12-month survival time (AUC = 0.64). The survival rate reached the 44% in a year. The median survival time to death or last follow-up time was 14.9 months (SD ± 15).
PathFx score model demonstrated the highest accuracy at predicting a survival time of 3 and 6 months. IOR score model was the most accurate measure at predicting a survival time of 12-months. To our knowledge, this is the first study reporting a comparative analysis of metastatic bone disease with predicting models in a country located in Latin America. PathFx’s and IOR score models are the ones to be used in the Chilean population as the predictive models in metastatic bone disease of the appendicular skeleton.
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Errani C, Mavrogenis AF, Cevolani L et al (2017) Treatment for long bone metastases based on a systematic literature review. Eur J Orthop Surg Traumatol 27:205–211. https://doi.org/10.1007/s00590-016-1857-9
Levin AS, Alcorn SR, Neuman BJ, Meyer CF (2019) Team Approach: Emergencies in Patients with Skeletal Metastases. JBJS Rev 7:e8. https://doi.org/10.2106/JBJS.RVW.18.00036
Coleman RE, Croucher PI, Padhani AR et al (2020) Bone metastases Nat Rev Dis Primer 6:83. https://doi.org/10.1038/s41572-020-00216-3
Bryson DJ, Wicks L, Ashford RU (2015) The investigation and management of suspected malignant pathological fractures: a review for the general orthopaedic surgeon. Injury 46:1891–1899. https://doi.org/10.1016/j.injury.2015.07.028
Hansen BH, Keller J, Laitinen M et al (2004) The Scandinavian Sarcoma Group Skeletal Metastasis Register. Survival after surgery for bone metastases in the pelvis and extremities. Acta Orthop Scand Suppl 75:11–15. https://doi.org/10.1080/00016470410001708270
Meares C, Badran A, Dewar D (2019) Prediction of survival after surgical management of femoral metastatic bone disease – A comparison of prognostic models. J Bone Oncol 15:100225. https://doi.org/10.1016/j.jbo.2019.100225
Errani C, Bazzocchi A, Spinnato P et al (2019) What’s new in management of bone metastases? Eur J Orthop Surg Traumatol 29:1367–1375. https://doi.org/10.1007/s00590-019-02446-y
Maccauro G, Muratori F, Liuzza F et al (2008) Anterograde femoral nail for the treatment of femoral metastases. Eur J Orthop Surg Traumatol 18:509–513. https://doi.org/10.1007/s00590-008-0343-4
Errani C, Cosentino M, Ciani G et al (2021) C-reactive protein and tumour diagnosis predict survival in patients treated surgically for long bone metastases. Int Orthop. https://doi.org/10.1007/s00264-020-04921-2
Katagiri H, Okada R, Takagi T et al (2014) New prognostic factors and scoring system for patients with skeletal metastasis. Cancer Med 3:1359–1367. https://doi.org/10.1002/cam4.292
Forsberg JA, Eberhardt J, Boland PJ et al (2011) Estimating survival in patients with operable skeletal metastases: an application of a bayesian belief network. PLoS ONE 6:e19956. https://doi.org/10.1371/journal.pone.0019956
Piccioli A, Maccauro G, Spinelli MS et al (2015) Bone metastases of unknown origin: epidemiology and principles of management. J Orthop Traumatol 16:81–86. https://doi.org/10.1007/s10195-015-0344-0
Willeumier JJ, van der Linden YM, van der Wal CWPG et al (2018) An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases: J Bone Jt Surg 100:196–204. https://doi.org/10.2106/JBJS.16.01514
Ratasvuori M, Wedin R, Keller J et al (2013) Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis. Surg Oncol 22:132–138. https://doi.org/10.1016/j.suronc.2013.02.008
Shimada H, Setoguchi T, Nakamura S et al (2015) Evaluation of prognostic scoring systems for bone metastases using single-center data. Mol Clin Oncol 3:1361–1370. https://doi.org/10.3892/mco.2015.637
Thio QCBS, Karhade AV, Bindels BJ et al (2020) Development and Internal Validation of Machine Learning Algorithms for Preoperative Survival Prediction of Extremity Metastatic Disease. Clin Orthop 478:322–333. https://doi.org/10.1097/CORR.0000000000000997
Bollen L, van der Linden YM, Pondaag W et al (2014) Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1 043 patients. Neuro-Oncol 16:991–998. https://doi.org/10.1093/neuonc/not318
Mirels H (1989) Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop 256–264
Piccioli A, Spinelli MS, Forsberg JA et al (2015) How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations. BMC Cancer 15:424. https://doi.org/10.1186/s12885-015-1396-5
Ogura K, Gokita T, Shinoda Y et al (2017) Can A Multivariate Model for Survival Estimation in Skeletal Metastases (PATHFx) Be Externally Validated Using Japanese Patients? Clin Orthop 475:2263–2270. https://doi.org/10.1007/s11999-017-5389-3
Anderson AB, Wedin R, Fabbri N et al (2020) External Validation of PATHFx Version 3.0 in Patients Treated Surgically and Nonsurgically for Symptomatic Skeletal Metastases. Clin Orthop 478:808–818. https://doi.org/10.1097/CORR.0000000000001081
Forsberg JA, Wedin R, Boland PJ, Healey JH (2017) Can We Estimate Short- and Intermediate-term Survival in Patients Undergoing Surgery for Metastatic Bone Disease? Clin Orthop 475:1252–1261. https://doi.org/10.1007/s11999-016-5187-3
Tanaka T, Imanishi J, Charoenlap C, Choong PFM (2016) Intramedullary nailing has sufficient durability for metastatic femoral fractures. World J Surg Oncol 14:80. https://doi.org/10.1186/s12957-016-0836-2
No funds were received for conducting this study.
Conflict of interest
Patricio A. Alfaro, Javier Delgado, Andres Dumas, Cecilia Mesa, Orlando Wevar, Carlos Herrera and Fabian Padilla declared not to have financial interests in this project. Eduardo Botello work with consultant honoraria from Company Zimmer-Biomet and Implancast. Also, he is President of the Latin American Orthopedic Musculoskeletal Tumors Society (SLATME), and a member of the Board of the International Society of Limb Salvage (ISOLS) and SICOT Chairman.
All procedures performed in the study involving human participants were in accordance with both, the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration (considering even its later amendments or comparable ethical standards).
This research was approved by the local research Ethics Committee to be carried out with waiver of informed consent.
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Alfaro, P.A., Delgado, J., Dumas, A. et al. Comparison between different prognostic models to be used for metastatic bone disease on appendicular skeleton in a Chilean population. Eur J Orthop Surg Traumatol 31, 1657–1662 (2021). https://doi.org/10.1007/s00590-021-03153-3
- Metastatic bone disease
- Metastatic cancer
- Impending and pathologic fractures
- Prognostic score
- Skeletal metastases