Development of a scoring system for survival following surgery for metastatic bone disease

Abstract

Aims The incidence of bone metastases is between 20% to 75% depending on the type of cancer. As treatment improves, the number of patients who need surgical intervention is increasing. Identifying patients with a shorter life expectancy would allow surgical intervention with more durable reconstructions to be targeted to those most likely to benefit. While previous scoring systems have focused on surgical and oncological factors, there is a need to consider comorbidities and the physiological state of the patient, as these will also affect outcome. The primary aim of this study was to create a scoring system to estimate survival time in patients with bony metastases and to determine which factors may adversely affect this. Methods This was a retrospective study which included all patients who had presented for surgery with metastatic bone disease. The data collected included patient, surgical, and oncological variables. Univariable and multivariable analysis identified which factors were associated with a survival time of less than six months and less than one year. A model to predict survival based on these factors was developed using Cox regression. Results A total of 164 patients were included with a median survival time of 1.6 years (interquartile range 0.5 to 3.1) after surgery. On multivariable analysis, a higher American Society of Anesthesiologists grade (p < 0.001), a high white cell count (p = 0.002), hyponatraemia (p = 0.001), a preoperative resting heart rate of > 100 bpm (p = 0.052), and the type of primary cancer (p = 0.026) remained significant predictors of reduced survival time. The predictive model developed showed good discrimination and calibration to predict both six- and 12-month survival in patients with metastatic bone disease. Conclusion In addition to surgical and oncological factors, the level of comorbidity and physiological state of the patient has a significant impact on survival in patients with metastatic bone disease. These factors should be considered when assessing the appropriateness of surgical intervention. This is the first study to examine other patient factors alongside surgical and oncological data to identify a relationship between these and survival. Cite this article: Bone Joint J 2021;103-B(11):1725–1730.

Survival of the GAP II cage in the management of metastatic disease of the acetabulum

“…The mean follow-up was 20 months which, although short compared with routine THA survivorship data, reflects the nature of the malignancy and high mortality rate in these patients. 22 Outcome scores were available for some patients, but these data were not considered to be robust enough to merit publication. Assessment of postoperative function and patient-reported outcomes would be of benefit to confirm that these high-risk procedures improve the patients' quality of life.…”

What’s New in Musculoskeletal Tumor Surgery

“…Table III shows some recent studies evaluating patients with metastatic bone disease [66][67][68][69][70][71][72][73][74][75][76] .…”

“…Predictive models and clinical risk assessment tools continue to be an area of active research in metastatic bone disease 67,[73][74][75][76] . The Skeletal Oncology Research Group (SORG) machinelearning (ML) algorithms have been widely studied as tools to estimate survival in patients with extremity metastases.…”

The use of the Baumber scoring system for metastatic disease of the vertebral column

“…More recently, a prognostic scoring system for survival following surgery for metastatic disease for the appendicular skeleton was developed by Baumber et al [10]. This scoring system was different to the Tokuhashi system [8] in that it assessed the patient as a series of interlinked body systems irrespective of the cancer, as opposed to the previous scoring systems which make assessments based on the burden of disease of the cancer in that individual.…”

“…This scoring system was different to the Tokuhashi system [8] in that it assessed the patient as a series of interlinked body systems irrespective of the cancer, as opposed to the previous scoring systems which make assessments based on the burden of disease of the cancer in that individual. Speci cally, Baumber et al [10] excluded spinal disease from their patient cohort because of the presence of previous scoring systems for spinal metastatic disease. Consequently, it is not known whether the ndings of Baumber et al [10] with regards the markers of body system health and survival after metastatic long bone disease are applicable to spinal metastatic disease.…”