1
|
You C, Ren J, Cheng L, Peng C, Lu P, Guo K, Zhong F, Wang J, Gao X, Cao J, Liu H, Liu T. Development and validation of a machine learning-based postoperative prognostic model for plasma cell neoplasia with spinal lesions as initial clinical manifestations: a single-center cohort study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08223-8. [PMID: 38584243 DOI: 10.1007/s00586-024-08223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Spinal multiple myeloma (MM) and solitary plasmacytoma of bone (SPB), both plasma cell neoplasms, greatly affect patients' quality of life due to spinal involvement. Accurate prediction of surgical outcomes is crucial for personalized patient care, but systematic treatment guidelines and predictive models are lacking. OBJECTIVE This study aimed to develop and validate a machine learning (ML)-based model to predict postoperative outcomes and identify prognostic factors for patients with spinal MM and SPB. METHODS A retrospective analysis was conducted on patients diagnosed with MM or SPB from 2011 to 2015, followed by prospective data collection from 2016 to 2017. Patient demographics, tumor characteristics, clinical treatments, and laboratory results were analyzed as input features. Four types of ML algorithms were employed for model development. The performance was assessed using discrimination and calibration measures, and the Shapley Additive exPlanations (SHAP) method was applied for model interpretation. RESULTS A total of 169 patients were included, with 119 for model training and 50 for validation. The Gaussian Naïve Bayes (GNB) model exhibited superior predictive accuracy and stability. Prospective validation on the 50 patients revealed an area under the curve (AUC) of 0.863, effectively distinguishing between 5-year survivors and non-survivors. Key prognostic factors identified included International Staging System (ISS) stage, Durie-Salmon (DS) stage, targeted therapy, and age. CONCLUSIONS The GNB model has the best performance and high reliability in predicting postoperative outcomes. Variables such as ISS stage and DS stage were significant in influencing patient prognosis. This study enhances the ability to identify patients at risk of poor outcomes, thereby aiding clinical decision-making.
Collapse
Affiliation(s)
- Chaoqun You
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Jiaji Ren
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Linfei Cheng
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China
- School of Medicine, Anhui University of Science and Technology, No.168 Taifeng Road, Huainan, 232001, China
| | - Cheng Peng
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Peng Lu
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, 200003, China
| | - Kai Guo
- Department of Orthopedics, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, No. 164 Lanxi Road, Shanghai, 200062, China
| | - Fulong Zhong
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Jing Wang
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Xin Gao
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China
| | - Jiashi Cao
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
- Department of Orthopedics, No. 455 Hospital of the Chinese People's Liberation Army, The Navy Medical University, No. 338 Huaihai West Road, Shanghai, 200052, China.
| | - Huancai Liu
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China.
| | - Tielong Liu
- Department of Joint Surgery, Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, 261061, China.
- Department of Orthopaedic Oncology, Changzheng Hospital of the Navy Medical University, No. 415 Fengyang Road, Shanghai, 200003, China.
| |
Collapse
|
2
|
Yang S, Fan G, Feng C, Fan Y, Xu N, Zhou H, Wang C, Liao X, He S. Novel Nomograms and Web-Based Tools Predicting Overall Survival and Cancer-specific Survival of Solitary Plasmacytoma of the Spine. Spine (Phila Pa 1976) 2023; 48:1197-1207. [PMID: 37036328 DOI: 10.1097/brs.0000000000004679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/30/2023] [Indexed: 04/11/2023]
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE This study aimed to establish nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in patients with solitary plasmacytoma of the spine (SPS). SUMMARY OF BACKGROUND DATA SPS is a rare type of malignant spinal tumor. A systematic study of prognostic factors associated with survival can provide guidance to clinicians and patients. Consideration of other causes of death (OCOD) in CSS will improve clinical practicability. METHODS A total of 1078 patients extracted from the SEER database between 2000 and 2018 were analyzed. Patients were grouped into training and testing data sets (7:3). Factors associated with OS and CSS were identified by Cox regression and competing risk regression, respectively, for the establishment of nomograms on a training data set. The testing data set was used for the external validation of the performance of the nomograms using calibration curves, Brier's scores, C-indexes, time-dependent receiver operating characteristic curves, and decision curve analysis (DCA). RESULTS Age and grade were identified as factors associated with both OS and CSS, along with marital status, radiation for OS, and chemotherapy for CSS. Heart disease, cerebrovascular disease, and diabetes mellitus were found to be the 3 most common causes of OCOD. The nomograms showed satisfactory agreement on calibration plots for both training and testing data sets. Integrated Brier score, C-index, and overall area under the curve on the testing data set were 0.162/0.717/0.789 and 0.173/0.709/0.756 for OS and CSS, respectively. DCA curves showed a good clinical net benefit. Nomogram-based web tools were developed for clinical application. CONCLUSION This study provides evidence for risk factors and prognostication of survival in SPS patients. The novel nomograms and web-based tools we developed demonstrated good performance and might serve as accessory tools for clinical decision-making and SPS management. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Sheng Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Guoxin Fan
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical school
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chaobo Feng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Yunshan Fan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Ningze Xu
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hongmin Zhou
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanfeng Wang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiang Liao
- Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Shenzhen University Medical school
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
3
|
Wu Y, Wei J, Chen S, Liu X, Cao J. A new prediction model for overall survival of elderly patients with solitary bone plasmacytoma: A population-based study. Front Public Health 2022; 10:954816. [PMID: 36176534 PMCID: PMC9513445 DOI: 10.3389/fpubh.2022.954816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Comprehensive studies on the prognosis of solitary bone plasmacytoma (SPB) are lacking, especially in elderly patients with SPB. This study aims to establish a novel nomogram and risk stratification system to predict the overall survival (OS) of elderly patients with SPB. Methods The data of elderly patients with SPB from 2000 to 2017 were identified in the SEER database. SPB patients were randomly assigned to the training set (n = 825) and validation set (n = 354). The Cox regression analysis was used to determine the independent risk factors for OS in elderly SPB patients. The nomogram was established and assessed by the area under the receiver operating curve (AUC), the consistency index (C-index), and the calibration plot. Patients were divided into low-, medium-, and high-risk groups based on the score of the nomogram. The Kaplan-Meier (K-M) curve was used to verify the differences in overall survival among the three groups. Result A total of 1,179 elderly patients with SPB were included in the study. Age at diagnosis, prior cancer before SPB, marital status, radiotherapy, and chemotherapy were independent risk factors of OS. The AUC of the 3, 5, and 8-year OS in the training and validation sets were between 0.707 and 0.860. The C-index and calibration plot also indicated that the nomogram has great predictive accuracy and robustness. After risk stratification, patients in the high-risk group had the worst OS. Conclusion A novel nomogram was built to predict the OS of elderly patients with SPB. It will help clinicians formulate more reasonable and personalized treatment strategies.
Collapse
Affiliation(s)
- Yingying Wu
- Department of Blood Transfusion, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiemin Wei
- Department of Hematology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shaomei Chen
- Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaozhu Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Xiaozhu Liu
| | - Junyi Cao
- Department of Medical Quality Control, The First People's Hospital of Zigong City, Zigong, China,Junyi Cao
| |
Collapse
|