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A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management
- Source :
- European Journal of Cancer, 107, 28-36, EUROPEAN JOURNAL OF CANCER, r-FISABIO: Repositorio Institucional de Producción Científica, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Choi, D, Pavlou, M, Omar, R, Arts, M, Balabaud, L, Buchowski, J M, Bunger, C, Chung, C K, Coppes, M H, Depreitere, B, Fehlings, M G, Kawahara, N, Lee, C-S, Leung, Y, Antonio Martin-Benlloch, J, Massicotte, E M, Mazel, C, Meyer, B, Oner, F C, Peul, W, Quraishi, N, Tokuhashi, Y, Tomita, K, Ulbricht, C, Verlaan, J-J, Wang, M & Crockard, H A 2019, ' A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management ', European Journal of Cancer, vol. 107, pp. 28-36 . https://doi.org/10.1016/j.ejca.2018.11.011, European Journal of Cancer, 107, 28-36. ELSEVIER SCI LTD, r-FISABIO. Repositorio Institucional de Producción Científica, instname
- Publication Year :
- 2019
- Publisher :
- ELSEVIER SCI LTD, 2019.
-
Abstract
- 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 Previous prognostic scoring systems are becoming out of date and inaccurate.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. ispartof: EUROPEAN JOURNAL OF CANCER vol:107 pages:28-36 ispartof: location:England status: published
- Subjects :
- 0301 basic medicine
Risk
Cancer Research
medicine.medical_specialty
Databases, Factual
Survival
Thoracic spine
medicine.medical_treatment
ACCURACY
Risk Assessment
Severity of Illness Index
Neurosurgical Procedures
VALIDATION
law.invention
Metastasis
EVENTS
03 medical and health sciences
0302 clinical medicine
Spine surgery
Predictive Value of Tests
law
Neoplasms
medicine
Humans
COHORT
Prospective Studies
Prospective cohort study
Outcome
Spinal Neoplasms
business.industry
CARDIOVASCULAR RISK
PROGNOSTIC SCORING SYSTEMS
CANCER
Confidence interval
Surgery
Radiation therapy
030104 developmental biology
Oncology
Calculator
030220 oncology & carcinogenesis
Cohort
Tumour
Spinal metastases
business
Patient database
Follow-Up Studies
Subjects
Details
- Language :
- English
- ISSN :
- 18790852 and 09598049
- Volume :
- 107
- Database :
- OpenAIRE
- Journal :
- European Journal of Cancer
- Accession number :
- edsair.doi.dedup.....3c85e4f53c80ed874b76df9970815161