Abstract | STUDY DESIGN: Retrospective and prospective cohort study. OBJECTIVES: Survival estimation is necessary in the decision-making process for treatment in patients with spinal metastasis from cancer of unknown primary (SMCUP). We aimed to develop a novel survival prediction system and compare its accuracy with that of existing survival models. METHODS: A retrospective derivation cohort of 268 patients and a prospective validation cohort of 105 patients with SMCUP were performed. Univariate and multivariable survival analysis were used to generate independently prognostic variables. A nomogram model for survival prediction was established by integrating these independent predictors based on the size of the significant variables' β regression coefficient. Then, the model was subjected to bootstrap validation with calibration curves and concordance index (C-index). Finally, predictive accuracy was compared with Tomita, revised Tokuhashi and SORG score by the receiver-operating characteristic (ROC) curve. RESULTS: The survival prediction model included six independent prognostic factors, including pathology (P < .001), visceral metastases (P < .001), Frankel score (P < .001), weight loss (P = .005), hemoglobin (P = .001) and serum tumor markers (P < .001). Calibration curve of the model showed good agreement between predicted and actual mortality risk in 6-, 12-, and 24-month estimation in derivation and validation cohorts. The C-index was .775 in the derivation cohort and .771 in the validation cohort. ROC curve analysis showed that the current model had the best accuracy for SMCUP survival estimation amongst 4 models. CONCLUSIONS: The novel nomogram system can be applied in survival prediction for SMCUP patients, and furtherly be used to give individualized therapeutic suggestions based on patients' prognosis.
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Authors | Minglei Yang, Xiaoyu Ma, Pengru Wang, Jiaxiang Yang, Nanzhe Zhong, Yujie Liu, Jun Shen, Wei Wan, Jian Jiao, Wei Xu, Jianru Xiao |
Journal | Global spine journal
(Global Spine J)
Vol. 14
Issue 1
Pg. 283-294
(Jan 2024)
ISSN: 2192-5682 [Print] England |
PMID | 35615968
(Publication Type: Journal Article)
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