title: Predictive Value of Six Prognostic Scoring Systems for Spinal Bone Metastases: An Analysis Based on 1379 Patients.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  The aim of this study was to assess and compare the predictive accuracy of six models designed to estimate survival of patients suffering from spinal bone metastases Just (SBMs).
  
  
  BACKGROUND
  On the basis of the estimated survival of patients with SBM, extent of treatment can be adjusted. To aid clinicians in the difficult task of assessing probability of survival, prognostic scoring systems have been developed by Tomita, Tokuhashi, Van der Linden, Bauer, Rades, and Bollen.
  
  
  METHODS
  All patients who were treated for SBM between 2000 and 2010 were included in this international, multicenter, retrospective study (n = 1379). Medical records were reviewed for all items needed to use the scoring systems. Survival time was calculated as the difference between start of treatment for SBM and date of death. Survival curves were estimated using the Kaplan-Meier method and accuracy was assessed with the c-statistic. Survival rates of the worst prognostic groups were evaluated at 4 months.
  
  
  RESULTS
  Median follow-up was 6.7 years [95% confidence interval (95% CI) 5.6-7.7] with a minimum of 2.3 years and a maximum of 12.3 years. The overall median survival was 5.1 months (95% CI 4.6-5.6). The most common primary tumors were breast (n = 388, 28%), lung (n = 318, 23%), and prostate cancer (n = 259, 19%). The Tokuhashi, Bauer, Tomita, and Van der Linden models performed similar with a c-statistic of 0.64 to 0.66 and a 4-month accuracy of 62% to 65%. The Rades model (c-statistic 0.44) and Bollen model (c-statistic 0.70) had a 4-month accuracy of 69% and 75%, respectively.
  
  
  CONCLUSIONS
  The Bollen model performs better than the other models. However, improvements are still warranted to increase the accuracy.
  
  
  METHODS
  3.
authors: *Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands†Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria‡Department of Clinical Oncology§Department of Neurosurgery¶Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
authors: Laurens
authors: L
authors: Bollen
authors: Christine
authors: C
authors: Wibmer
authors: Yvette M
authors: YM
authors: Van der Linden
authors: Willem
authors: W
authors: Pondaag
authors: Marta
authors: M
authors: Fiocco
authors: Wilco C
authors: WC
authors: Peul
authors: Corrie A M
authors: CA
authors: Marijnen
authors: Rob G H H
authors: RG
authors: Nelissen
authors: Andreas
authors: A
authors: Leithner
authors: Sander P D
authors: SP
authors: Dijkstra
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000556:secondary; D015996:Survival Rate / Q000639:trends; D013904:Thoracic Vertebrae