Can We Estimate Short- and Intermediate-term Survival in Patients Undergoing Surgery for Metastatic Bone Disease?

Abstract

Background Objective means of estimating survival can be used to guide surgical decision-making and to risk-stratify patients for clinical trials. Although a free, online tool (www. pathfx.org) can estimate 3-and 12-month survival, recent work, including a survey of the Musculoskeletal Tumor Society, indicated that estimates at 1 and 6 months after surgery also would be helpful. Longer estimates help justify the need for more durable and expensive reconstructive options, and very short estimates could help identify those who will not survive 1 month and should not undergo surgery. Thereby, an important use of this tool would be to help avoid unsuccessful and expensive surgery during the last month of life. Questions/Purposes We seek to provide a reliable, objective means of estimating survival in patients with metastatic bone disease. After generating models to derive 1-and 6-month survival estimates, we determined suitability for clinical use by applying receiver operator 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, and that informed consent for participation in the study was obtained. This work was performed at the Naval Medical Research Center, Silver Spring, MD, USA. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, nor the U.S. Government. Research activities leading to the development of this abstract were approved by the local Institutional Review Board (NMRC.2014.0009 and IRBNet 392350) in compliance with all applicable regulations governing the protection of human subjects. One of the authors (JAF) is a military service member. This work was supported/funded by work-unit number HU0001-14-1-0010 and was prepared as part of his official duties. Title 17 U.S.C. §105 provides that ''Copyright protection under this title is not available for any work of the United States Government''. Title 17 U.S.C. §101 defines a U.S. government work as a work prepared by a military service member or employee of the U.S. Government as part of that person's official duties. We certify that the document represents valid work; that if we used information derived from another source, we obtained all necessary approvals to use it and made appropriate acknowledgements in the document; and we take public responsibility for it. 123 Clin Orthop Relat Res (2017) 475:1252-1261 DOI 10.1007/s11999-016-5187-3 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® characteristic (ROC) (area under the curve [AUC] [ 0.7)and decision curve analysis (DCA), which determines whether using PATHFx can improve outcomes, but also discerns in which kinds of patients PATHFx should not be used. Methods We used two, existing, skeletal metastasis registries chosen for their quality and availability. Data from Memorial Sl...

Serum albumin level predicts survival after surgical treatment of metastatic femur fractures: a retrospective study

“…We report a 30-day mortality of 13.4% which Median values and interquartile ranges reported for age, albumin, haemoglobin and time of diagnosis of cancer to incidence of pathological fracture is similar to that previously reported (2.6 to 12%) [14][15][16]. One-year and 2-year mortality in our patients were 67% and 85.7% respectively, compared to previously reported mortality rates of 60-83% at 1 year and 70-94% at 2 years [2][3][4][5][6][7][8][9]. Regarding short-term outcomes, poor ASA and functional status have been previously found to be significant risk factors for 30-day mortality [15].…”

“…Primaries from paired structures such as the breast, prostate, lungs, thyroid and kidneys are known to metastasise to bone commonly, with the femur being the most likely long bone to be affected by bony metastasis (44%) [1]. Patients with metastatic pathological femur fractures are associated with higher mortality rates of 60-83% at 1-year and 70-94% at 2 years after surgical treatment [2][3][4][5][6][7][8][9] compared with the 1-year mortality rate of about 12 to 37% for traumatic hip fractures [10]. Nevertheless, surgical intervention may be necessary to restore function and provide pain relief.…”

“…Goal of palliative treatment is to maximise patients' welfare and quality of life in their remaining days and accurate assessment of their survival is needed to prevent unnecessary invasive procedures which may not be beneficial to patients [12]. Some risk factors for mortality have been identified including site of primary tumour [2][3][4][5][6][7][8] and preoperative functional status [2,[6][7][8] in the literature. However, there is no strong consensus on the other risk factors for survival in patients with metastatic pathological femur fractures.…”

“…This would help aid decision-making by surgeons and patients especially for patients with mid-term estimations [12]. The most recent and comprehensive are the updated models of Katagiri et al [13] and model by Forsberg et al [3] However, only the model by Forsberg et al has been validated in several small external cohorts and a recent survey shows that utilisation of these models could be improved [12].…”

CORR Insights®: Can A Multivariate Model for Survival Estimation in Skeletal Metastases (PATHFx) Be Externally Validated Using Japanese Patients?

“…In their study, Ogura and colleagues performed external validation in a Japanese population of the PATHFx model (www.pathfx.org) that predicts 1, 3, 6 and 12-month postsurgical survival of patients with skeletal metastases. The PATHFx model was developed and validated for Western countries patients [2][3][4]9], and the validation in an Asian population therefore represents a step forward in the evaluation of the applicability of model worldwide.…”