An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases

J J Willeumier; Y M van der Linden; C W P G van der Wal; P C Jutte; J M van der Velden; M A Smolle; P van der Zwaal; P Koper; L Bakri; I de Pree; A Leithner; M Fiocco; P D S Dijkstra

doi:10.2106/JBJS.16.01514

An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases

J J Willeumier, Y M van der Linden, C W P G van der Wal, P C Jutte, J M van der Velden, M A Smolle, P van der Zwaal, P Koper, L Bakri, I de Pree, A Leithner, M Fiocco, P D S Dijkstra

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Abstract

BACKGROUND: A survival estimation for patients with symptomatic long bone metastases (LBM) is crucial to prevent overtreatment and undertreatment. This study analyzed prognostic factors for overall survival and developed a simple, easy-to-use prognostic model.

METHODS: A multicenter retrospective study of 1,520 patients treated for symptomatic LBM between 2000 and 2013 at the radiation therapy and/or orthopaedic departments was performed. Primary tumors were categorized into 3 clinical profiles (favorable, moderate, or unfavorable) according to an existing classification system. Associations between prognostic variables and overall survival were investigated using the Kaplan-Meier method and multivariate Cox regression models. The discriminatory ability of the developed model was assessed with the Harrell C-statistic. The observed and expected survival for each survival category were compared on the basis of an external cohort.

RESULTS: Median overall survival was 7.4 months (95% confidence interval [CI], 6.7 to 8.1 months). On the basis of the independent prognostic factors, namely the clinical profile, Karnofsky Performance Score, and presence of visceral and/or brain metastases, 12 prognostic categories were created. The Harrell C-statistic was 0.70. A flowchart was developed to easily stratify patients. Using cutoff points for clinical decision-making, the 12 categories were narrowed down to 4 categories with clinical consequences. Median survival was 21.9 months (95% CI, 18.7 to 25.1 months), 10.5 months (95% CI, 7.9 to 13.1 months), 4.6 months (95% CI, 3.9 to 5.3 months), and 2.2 months (95% CI, 1.8 to 2.6 months) for the 4 categories.

CONCLUSIONS: This study presents a model to easily stratify patients with symptomatic LBM according to their expected survival. The simplicity and clarity of the model facilitate and encourage its use in the routine care of patients with LBM, to provide the most appropriate treatment for each individual patient.

LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original language	English
Pages (from-to)	196-204
Number of pages	9
Journal	Journal of Bone and Joint Surgery: American Volume
Volume	100
Issue number	3
DOIs	https://doi.org/10.2106/JBJS.16.01514
Publication status	Published - 7-Feb-2018

Keywords

Journal Article
BREAST
LUNG
SKELETAL METASTASES
CANCER-PATIENTS
DISEASE
CARCINOMA

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Willeumier, J. J., van der Linden, Y. M., van der Wal, C. W. P. G., Jutte, P. C., van der Velden, J. M., Smolle, M. A., van der Zwaal, P., Koper, P., Bakri, L., de Pree, I., Leithner, A., Fiocco, M., & Dijkstra, P. D. S. (2018). An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases. Journal of Bone and Joint Surgery: American Volume, 100(3), 196-204. https://doi.org/10.2106/JBJS.16.01514

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title = "An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases",

abstract = "BACKGROUND: A survival estimation for patients with symptomatic long bone metastases (LBM) is crucial to prevent overtreatment and undertreatment. This study analyzed prognostic factors for overall survival and developed a simple, easy-to-use prognostic model.METHODS: A multicenter retrospective study of 1,520 patients treated for symptomatic LBM between 2000 and 2013 at the radiation therapy and/or orthopaedic departments was performed. Primary tumors were categorized into 3 clinical profiles (favorable, moderate, or unfavorable) according to an existing classification system. Associations between prognostic variables and overall survival were investigated using the Kaplan-Meier method and multivariate Cox regression models. The discriminatory ability of the developed model was assessed with the Harrell C-statistic. The observed and expected survival for each survival category were compared on the basis of an external cohort.RESULTS: Median overall survival was 7.4 months (95% confidence interval [CI], 6.7 to 8.1 months). On the basis of the independent prognostic factors, namely the clinical profile, Karnofsky Performance Score, and presence of visceral and/or brain metastases, 12 prognostic categories were created. The Harrell C-statistic was 0.70. A flowchart was developed to easily stratify patients. Using cutoff points for clinical decision-making, the 12 categories were narrowed down to 4 categories with clinical consequences. Median survival was 21.9 months (95% CI, 18.7 to 25.1 months), 10.5 months (95% CI, 7.9 to 13.1 months), 4.6 months (95% CI, 3.9 to 5.3 months), and 2.2 months (95% CI, 1.8 to 2.6 months) for the 4 categories.CONCLUSIONS: This study presents a model to easily stratify patients with symptomatic LBM according to their expected survival. The simplicity and clarity of the model facilitate and encourage its use in the routine care of patients with LBM, to provide the most appropriate treatment for each individual patient.LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.",

keywords = "Journal Article, BREAST, LUNG, SKELETAL METASTASES, CANCER-PATIENTS, DISEASE, CARCINOMA",

author = "Willeumier, {J J} and {van der Linden}, {Y M} and {van der Wal}, {C W P G} and Jutte, {P C} and {van der Velden}, {J M} and Smolle, {M A} and {van der Zwaal}, P and P Koper and L Bakri and {de Pree}, I and A Leithner and M Fiocco and Dijkstra, {P D S}",

year = "2018",

month = feb,

day = "7",

doi = "10.2106/JBJS.16.01514",

language = "English",

volume = "100",

pages = "196--204",

journal = "Journal of Bone and Joint Surgery: American Volume",

issn = "0021-9355",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "3",

}

Willeumier, JJ, van der Linden, YM, van der Wal, CWPG, Jutte, PC, van der Velden, JM, Smolle, MA, van der Zwaal, P, Koper, P, Bakri, L, de Pree, I, Leithner, A, Fiocco, M & Dijkstra, PDS 2018, 'An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases', Journal of Bone and Joint Surgery: American Volume, vol. 100, no. 3, pp. 196-204. https://doi.org/10.2106/JBJS.16.01514

TY - JOUR

T1 - An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases

AU - Willeumier, J J

AU - van der Linden, Y M

AU - van der Wal, C W P G

AU - Jutte, P C

AU - van der Velden, J M

AU - Smolle, M A

AU - van der Zwaal, P

AU - Koper, P

AU - Bakri, L

AU - de Pree, I

AU - Leithner, A

AU - Fiocco, M

AU - Dijkstra, P D S

PY - 2018/2/7

Y1 - 2018/2/7

N2 - BACKGROUND: A survival estimation for patients with symptomatic long bone metastases (LBM) is crucial to prevent overtreatment and undertreatment. This study analyzed prognostic factors for overall survival and developed a simple, easy-to-use prognostic model.METHODS: A multicenter retrospective study of 1,520 patients treated for symptomatic LBM between 2000 and 2013 at the radiation therapy and/or orthopaedic departments was performed. Primary tumors were categorized into 3 clinical profiles (favorable, moderate, or unfavorable) according to an existing classification system. Associations between prognostic variables and overall survival were investigated using the Kaplan-Meier method and multivariate Cox regression models. The discriminatory ability of the developed model was assessed with the Harrell C-statistic. The observed and expected survival for each survival category were compared on the basis of an external cohort.RESULTS: Median overall survival was 7.4 months (95% confidence interval [CI], 6.7 to 8.1 months). On the basis of the independent prognostic factors, namely the clinical profile, Karnofsky Performance Score, and presence of visceral and/or brain metastases, 12 prognostic categories were created. The Harrell C-statistic was 0.70. A flowchart was developed to easily stratify patients. Using cutoff points for clinical decision-making, the 12 categories were narrowed down to 4 categories with clinical consequences. Median survival was 21.9 months (95% CI, 18.7 to 25.1 months), 10.5 months (95% CI, 7.9 to 13.1 months), 4.6 months (95% CI, 3.9 to 5.3 months), and 2.2 months (95% CI, 1.8 to 2.6 months) for the 4 categories.CONCLUSIONS: This study presents a model to easily stratify patients with symptomatic LBM according to their expected survival. The simplicity and clarity of the model facilitate and encourage its use in the routine care of patients with LBM, to provide the most appropriate treatment for each individual patient.LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

AB - BACKGROUND: A survival estimation for patients with symptomatic long bone metastases (LBM) is crucial to prevent overtreatment and undertreatment. This study analyzed prognostic factors for overall survival and developed a simple, easy-to-use prognostic model.METHODS: A multicenter retrospective study of 1,520 patients treated for symptomatic LBM between 2000 and 2013 at the radiation therapy and/or orthopaedic departments was performed. Primary tumors were categorized into 3 clinical profiles (favorable, moderate, or unfavorable) according to an existing classification system. Associations between prognostic variables and overall survival were investigated using the Kaplan-Meier method and multivariate Cox regression models. The discriminatory ability of the developed model was assessed with the Harrell C-statistic. The observed and expected survival for each survival category were compared on the basis of an external cohort.RESULTS: Median overall survival was 7.4 months (95% confidence interval [CI], 6.7 to 8.1 months). On the basis of the independent prognostic factors, namely the clinical profile, Karnofsky Performance Score, and presence of visceral and/or brain metastases, 12 prognostic categories were created. The Harrell C-statistic was 0.70. A flowchart was developed to easily stratify patients. Using cutoff points for clinical decision-making, the 12 categories were narrowed down to 4 categories with clinical consequences. Median survival was 21.9 months (95% CI, 18.7 to 25.1 months), 10.5 months (95% CI, 7.9 to 13.1 months), 4.6 months (95% CI, 3.9 to 5.3 months), and 2.2 months (95% CI, 1.8 to 2.6 months) for the 4 categories.CONCLUSIONS: This study presents a model to easily stratify patients with symptomatic LBM according to their expected survival. The simplicity and clarity of the model facilitate and encourage its use in the routine care of patients with LBM, to provide the most appropriate treatment for each individual patient.LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

KW - Journal Article

KW - BREAST

KW - LUNG

KW - SKELETAL METASTASES

KW - CANCER-PATIENTS

KW - DISEASE

KW - CARCINOMA

U2 - 10.2106/JBJS.16.01514

DO - 10.2106/JBJS.16.01514

M3 - Article

C2 - 29406340

SN - 0021-9355

VL - 100

SP - 196

EP - 204

JO - Journal of Bone and Joint Surgery: American Volume

JF - Journal of Bone and Joint Surgery: American Volume

IS - 3

ER -

An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases

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