Prognostic significance of lab data and performance comparison by validating survival prediction models for patients with spinal metastases after radiotherapy

Yen, Hung-Kuan; Hu, Ming-Hsiao; Zijlstra, Hester; Groot, Olivier Q.; Hsieh, Hsiang-Chieh; Yang, Jyh‐Chin; Karhade, Aditya V.; Chen, Po-Chao; Chen, Yuhan; Huang, Pei-Ming; Chen, Yu-Hung; Xiao, Furen; Verlaan, Jorrit‐Jan; Schwab, Joseph H.; Yang, Rong‐Sen; Yang, Sen; Lin, Wei-Hsin; Hsu, Feng‐Ming

doi:10.1016/j.radonc.2022.08.029

Cited by 7 publications

(11 citation statements)

References 48 publications

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“…In our study, only laboratory data before RT had a large impact for both survival and LC in patients with palliative RT. Many studies showed that laboratory data were important for prediction of survival [ 14 , 22 , 23 , 24 , 25 ]. These laboratory data are considered to represent the tumor aggressiveness.…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

et al. 2023

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The aim of this study was to evaluate the expected prognosis and factors affecting local control (LC) of the bone metastatic sites treated with palliative external beam radiotherapy (RT). Between December 2010 and April 2019, 420 cases (male/female = 240/180; median age [range]: 66 [12–90] years) with predominantly osteolytic bone metastases received RT and were evaluated. LC was evaluated by follow-up computed tomography (CT) image. Median RT doses (BED10) were 39.0 Gy (range, 14.4–71.7 Gy). The 0.5-year overall survival and LC of RT sites were 71% and 84%, respectively. Local recurrence on CT images was observed in 19% (n = 80) of the RT sites, and the median recurrence time was 3.5 months (range, 1–106 months). In univariate analysis, abnormal laboratory data before RT (platelet count, serum albumin, total bilirubin, lactate dehydrogenase, or serum calcium level), high-risk primary tumor sites (colorectal, esophageal, hepatobiliary/pancreatic, renal/ureter, and non-epithelial cancers), no antineoplastic agents (ATs) administration after RT, and no bone modifying agents (BMAs) administration after RT were significantly unfavorable factors for both survival and LC of RT sites. Sex (male), performance status (≥3), and RT dose (BED10) (<39.0 Gy) were significantly unfavorable factors for only survival, and age (≥70 years) and bone cortex destruction were significantly unfavorable factors for only LC of RT sites. In multivariate analysis, only abnormal laboratory data before RT influenced both unfavorable survival and LC of RT sites. Performance status (≥3), no ATs administration after RT, RT dose (BED10) (<39.0 Gy), and sex (male) were significantly unfavorable factors for survival, and primary tumor sites and BMAs administration after RT were significantly unfavorable factors for LC of RT sites. In conclusion, laboratory data before RT was important factor both prognosis and LC of bone metastases treated with palliative RT. At least in patients with abnormal laboratory data before RT, palliative RT seemed to be focused on the only pain relief.

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

et al. 2023

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“…11,35,36 Also, the SORG-MLA tended to underestimate the survival of Taiwanese patients. 1,3,11 To avoid bias, we tested multiple cutoffs in sensitivity analyses and showed that SORG-MLA was still clinically useful. When applying 50% and 70% as cut points, a surgical intervention was more cost-effective for the patients with better predicted survival probabilities while not cost-effective for the counterpart.…”

Section: Discussionmentioning

confidence: 99%

“…Published data were referenced to derive the therapeutic efficacy, 2,16,18,19 30‐day mortality rate, 2,17–21 complication rate, 14,17,20,22,23 and the other transition probabilities that occurred infrequently (Table S1). 2,17,19,22–30 Monthly mortality rate of each subgroup was derived from our own cohort, which is adjusted from the one‐year all‐cause mortality rate 3 . The 2019 Medicare fee schedule, which was consistent with the cohort enrollment period, was referenced to calculate the costs of operative and nonoperative treatments 31 .…”

Section: Methodsmentioning

confidence: 99%

“…Adult patients with spinal metastasis who were treated with surgery and/or radiotherapy between 2010 and 2018 at a tertiary center (n = 2768) were retrospectively included. 3 The median age was 61 (interquartile range [IQR], 53-70), and 45% (1238/2768) were female. 22% of the patients (617/2768) received surgical intervention for spinal metastasis, and the remaining 78% (2151/2768) were treated with radiotherapy.…”

Section: Patient Selectionmentioning

confidence: 99%

“…1,2 Otherwise, radiotherapy should be considered for symptom relief. 3 The rationale is that only patients with better prognosis have enough time to recover from such major operations. Unfortunately, to the best of our knowledge, no previous cost-effective analysis lends support to the hypothesis.…”

Section: Introductionmentioning

confidence: 99%

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Determining patients with spinal metastases suitable for surgical intervention: A cost‐effective analysis

Hsieh,

Yen,

Tseng

et al. 2023

Cancer Medicine

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BackgroundBoth nonoperative and operative treatments for spinal metastasis are expensive interventions. Patients' expected 3‐month survival is believed to be a key factor to determine the most suitable treatment. However, to the best of our knowledge, no previous study lends support to the hypothesis. We sought to determine the cost‐effectiveness of operative and nonoperative interventions, stratified by patients' predicted probability of 3‐month survival.MethodsA Markov model with four defined health states was used to estimate the quality‐adjusted life years (QALYs) and costs for operative intervention with postoperative radiotherapy and radiotherapy alone (palliative low‐dose external beam radiotherapy) of spine metastases. Transition probabilities for the model, including the risks of mortality and functional deterioration, were obtained from secondary and our institutional data. Willingness to pay thresholds were prespecified at $100,000 and $150,000. The analyses were censored after 5‐year simulation from a health system perspective and discounted outcomes at 3% per year. Sensitivity analyses were conducted to test the robustness of the study design.ResultsThe incremental cost‐effectiveness ratios were $140,907 per QALY for patients with a 3‐month survival probability >50%, $3,178,510 per QALY for patients with a 3‐month survival probability <50%, and $168,385 per QALY for patients with independent ambulatory and 3‐month survival probability >50%.ConclusionsThis study emphasizes the need to choose patients carefully and estimate preoperative survival for those with spinal metastases. In addition to reaffirming previous research regarding the influence of ambulatory status on cost‐effectiveness, our study goes a step further by highlighting that operative intervention with postoperative radiotherapy could be more cost‐effective than radiotherapy alone for patients with a better survival outlook. Accurate survival prediction tools and larger future studies could offer more detailed insights for clinical decisions.

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Fostering reproducibility and generalizability in machine learning for clinical prediction modeling in spine surgery

Yen

Yang²,

Groot³

et al. 2023

The Spine Journal

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Prognostic significance of lab data and performance comparison by validating survival prediction models for patients with spinal metastases after radiotherapy

Cited by 7 publications

References 48 publications

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

Factors Affecting Survival and Local Control in Patients with Bone Metastases Treated with Radiotherapy

Determining patients with spinal metastases suitable for surgical intervention: A cost‐effective analysis

Fostering reproducibility and generalizability in machine learning for clinical prediction modeling in spine surgery

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