The Prediction of Survival after Surgical Management of Bone Metastases of the Extremities—A Comparison of Prognostic Models

Abstract

Individualized survival prognostic models for symptomatic patients with appendicular metastatic bone disease are key to guiding clinical decision-making for the orthopedic surgeon. Several prognostic models have been developed in recent years; however, most orthopedic surgeons have not incorporated these models into routine practice. This is possibly due to uncertainty concerning their accuracy and the lack of comparison publications and recommendations. Our aim was to conduct a review and quality assessment of these models. A computerized literature search in MEDLINE, EMBASE and PubMed up to February 2022 was done, using keywords: “Bone metastasis”, “survival”, “extremity” and “prognosis”. We evaluated each model’s performance, assessing the estimated discriminative power and calibration accuracy for the analyzed patients. We included 11 studies out of the 1779 citations initially retrieved. The 11 studies included seven different models for estimating survival. Among externally validated survival prediction scores, PATHFx 3.0, 2013-SPRING and potentially Optimodel were found to be the best models in terms of performance. Currently, it is still a challenge to recommend any of the models as the standard for predicting survival for these patients. However, some models show better performance status and other quality characteristics. We recommend future, large, multicenter, prospective studies to compare between PATHfx 3.0, SPRING 2013 and OptiModel using the same external validation dataset.

Comparison of survival prediction models for bone metastases of the extremities following surgery

“…However, the simplicity exists at a trade-off for reduced model performance. 11 We assert that internet application such as that presented by the PATHFx3.0 and SORG models provides enough convenience for the prediction models to incorporate more tumour- and patient-specific data for a better tailored prediction without notably reducing the user experience. In conclusion, state-of-art survival prediction models for BM-E (PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR models) are useful tools for orthopaedic surgeons in the decision-making process for treatment in Asian patients, with SORG models offering the best predictive performance.…”

“…[8][9][10] Previous literature has narrowed candidates for externally validated survival prediction models with good predictive performance. [9][10][11] Of these, we chose five models (PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR) to compare and test for generalizability in our Korean cohort. 9,[12][13][14][15] This is the first study to compare directly postoperative survival prediction models for BM-E in an Asian cohort.…”

“…8-10 Previous literature has narrowed candidates for externally validated survival prediction models with good predictive performance. 9-11 Of these, we chose five models (PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR) to compare and test for generalizability in our Korean cohort. 9,12-15…”

Functional and Survival Outcomes of Patients following the Harrington Procedure for Complex Acetabular Metastatic Lesions

“…A precise prognosis analysis is mandatory. The Katagiri predictive score was used in our daily practice, and other efficient tools such as PATHFx or OPTModel have since been developed for this purpose [ 42 , 43 , 44 ].…”

Treatment of Bone Metastasis

“…Ben-Gal et al evaluated each model’s performance, assessing the estimated discriminative power and calibration accuracy for patients with bone metastases. Among externally validated survival prediction scores, the PathFx model, SPRING and Optimodel were found to be the best models in terms of performance [ 11 ]. These data contribute to increasing our knowledge on the prognostic scores of patients with bone metastasis that have already been published previously [ 12 , 13 ].…”