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Pan YT, Lin YP, Yen HK, Yen HH, Huang CC, Hu MH, Lin WH, Hsieh HC. Reply to the Letter to the Editor: Are Current Survival Prediction Tools Useful When Treating Subsequent Skeletal-related Events From Bone Metastases? Clin Orthop Relat Res 2024; 482:1910-1911. [PMID: 39017594 PMCID: PMC11419556 DOI: 10.1097/corr.0000000000003191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Yu-Ting Pan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Po Lin
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Hung-Kuan Yen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Ho Yen
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Ching Huang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hsiao Hu
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Hsin Lin
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsiang-Chieh Hsieh
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
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Yang M, Zhong N, Dai Z, Ma X, Leng A, Zhou Y, Wang J, Jiao J, Xiao J. Risks for prolonged mechanical ventilation and reintubation after cervical malignant tumor surgery: a nested case-control 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; 33:3069-3081. [PMID: 38907855 DOI: 10.1007/s00586-024-08313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/15/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE Prolonged mechanical ventilation (PMV) and reintubation are among the most serious postoperative adverse events associated with malignant cervical tumors. In this study, we aimed to clarify the incidence, characteristics, and risk factors for PMV and reintubation in target patients. METHODS This retrospective nested case-control study was performed between January 2014 and January 2020 at a large spinal tumor center in China. Univariate analysis was used to identify the possible risk factors associated with PMV and reintubation. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) with covariates of a probability < 0.05 in univariate analysis. RESULTS From a cohort of 560 patients with primary malignant (n = 352) and metastatic (n = 208) cervical tumors, 27 patients required PMV and 20 patients underwent reintubation. The incidence rates of PMV and reintubation were 4.82% and 3.57%, respectively. Three variables (all p < 0.05) were independently associated with an increased risk of PMV: Karnofsky Performance Status < 50 compared to ≥ 80, operation duration ≥ 8 h compared to < 6 h, and C4 nerve root encased by the tumor. Longer operative duration and preoperative hypercapnia (all p < 0.05) were independent risk factors for postoperative reintubation, both of which led to longer length of stay (32.6 ± 30.8 vs. 10.7 ± 5.95 days, p < 0.001), with an in-hospital mortality of 17.0%. CONCLUSION Our results demonstrate the risk factors for PMV or reintubation after surgery for malignant cervical tumors. Adequate assessment, early detection, and prevention are necessary for this high-risk population.
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Affiliation(s)
- Minglei Yang
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Nanzhe Zhong
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Zeyu Dai
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Xiaoyu Ma
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Ao Leng
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China
- Department of Orthopedics, 966 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Dandong, 118000, China
| | - Yangyang Zhou
- Department of Anesthesiology, The Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Jing Wang
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Jian Jiao
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Jianru Xiao
- Department of Orthopedic Oncology, The Second Affiliated Hospital of Naval Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Wang S, Chen Z, Wang K, Li H, Qu H, Mou H, Lin N, Ye Z. Effect of radiotherapy on local control and overall survival in spinal metastasis of non-small-cell lung cancer after surgery and systemic therapy. Bone Jt Open 2024; 5:350-360. [PMID: 38649150 PMCID: PMC11035006 DOI: 10.1302/2633-1462.54.bjo-2024-0037.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Aims Radiotherapy is a well-known local treatment for spinal metastases. However, in the presence of postoperative systemic therapy, the efficacy of radiotherapy on local control (LC) and overall survival (OS) in patients with spinal metastases remains unknown. This study aimed to evaluate the clinical outcomes of post-surgical radiotherapy for spinal metastatic non-small-cell lung cancer (NSCLC) patients, and to identify factors correlated with LC and OS. Methods A retrospective, single-centre review was conducted of patients with spinal metastases from NSCLC who underwent surgery followed by systemic therapy at our institution from January 2018 to September 2022. Kaplan-Meier analysis and log-rank tests were used to compare the LC and OS between groups. Associated factors for LC and OS were assessed using Cox proportional hazards regression analysis. Results Overall, 123 patients with 127 spinal metastases from NSCLC who underwent decompression surgery followed by postoperative systemic therapy were included. A total of 43 lesions were treated with stereotactic body radiotherapy (SBRT) after surgery and 84 lesions were not. Survival rate at one, two, and three years was 83.4%, 58.9%, and 48.2%, respectively, and LC rate was 87.8%, 78.8%, and 78.8%, respectively. Histological type was the only significant associated factor for both LC (p = 0.007) and OS (p < 0.001). Treatment with targeted therapy was significantly associated with longer survival (p = 0.039). The risk factors associated with worse survival were abnormal laboratory data (p = 0.021), lesions located in the thoracic spine (p = 0.047), and lumbar spine (p = 0.044). This study also revealed that postoperative radiotherapy had little effect in improving OS or LC. Conclusion Tumour histological type was significantly associated with the prognosis in spinal NSCLC metastasis patients. In the presence of post-surgical systemic therapy, radiotherapy appeared to be less effective in improving LC, OS, or quality of life in spinal NSCLC metastasis patients.
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Affiliation(s)
- Shengdong Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zehao Chen
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Keyi Wang
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hengyuan Li
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Hao Qu
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Haochen Mou
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Nong Lin
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopedics, Musculoskeletal Tumor Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
- Institute of Orthopedic Research, Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China
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Suzuki A, Terai H, Takahashi S, Kato M, Toyoda H, Tamai K, Hori Y, Okamura Y, Nakamura H. Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors. J Clin Med 2023; 12:jcm12103442. [PMID: 37240548 DOI: 10.3390/jcm12103442] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/06/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient's condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors.
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Affiliation(s)
- Akinobu Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Minori Kato
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Yusuke Hori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Yuki Okamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka 545-8585, Japan
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Cui Y, Wang Q, Shi X, Ye Q, Lei M, Wang B. Development of a web-based calculator to predict three-month mortality among patients with bone metastases from cancer of unknown primary: An internally and externally validated study using machine-learning techniques. Front Oncol 2022; 12:1095059. [PMID: 36568149 PMCID: PMC9768185 DOI: 10.3389/fonc.2022.1095059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background Individualized therapeutic strategies can be carried out under the guidance of expected lifespan, hence survival prediction is important. Nonetheless, reliable survival estimation in individuals with bone metastases from cancer of unknown primary (CUP) is still scarce. The objective of the study is to construct a model as well as a web-based calculator to predict three-month mortality among bone metastasis patients with CUP using machine learning-based techniques. Methods This study enrolled 1010 patients from a large oncological database, the Surveillance, Epidemiology, and End Results (SEER) database, in the United States between 2010 and 2018. The entire patient population was classified into two cohorts at random: a training cohort (n=600, 60%) and a validation cohort (410, 40%). Patients from the validation cohort were used to validate models after they had been developed using the four machine learning approaches of random forest, gradient boosting machine, decision tree, and eXGBoosting machine on patients from the training cohort. In addition, 101 patients from two large teaching hospital were served as an external validation cohort. To evaluate each model's ability to predict the outcome, prediction measures such as area under the receiver operating characteristic (AUROC) curves, accuracy, and Youden index were generated. The study's risk stratification was done using the best cut-off value. The Streamlit software was used to establish a web-based calculator. Results The three-month mortality was 72.38% (731/1010) in the entire cohort. The multivariate analysis revealed that older age (P=0.031), lung metastasis (P=0.012), and liver metastasis (P=0.008) were risk contributors for three-month mortality, while radiation (P=0.002) and chemotherapy (P<0.001) were protective factors. The random forest model showed the highest area under curve (AUC) value (0.796, 95% CI: 0.746-0.847), the second-highest precision (0.876) and accuracy (0.778), and the highest Youden index (1.486), in comparison to the other three machine learning approaches. The AUC value was 0.748 (95% CI: 0.653-0.843) and the accuracy was 0.745, according to the external validation cohort. Based on the random forest model, a web calculator was established: https://starxueshu-codeok-main-8jv2ws.streamlitapp.com/. When compared to patients in the low-risk groups, patients in the high-risk groups had a 1.99 times higher chance of dying within three months in the internal validation cohort and a 2.37 times higher chance in the external validation cohort (Both P<0.001). Conclusions The random forest model has promising performance with favorable discrimination and calibration. This study suggests a web-based calculator based on the random forest model to estimate the three-month mortality among bone metastases from CUP, and it may be a helpful tool to direct clinical decision-making, inform patients about their prognosis, and facilitate therapeutic communication between patients and physicians.
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Affiliation(s)
- Yunpeng Cui
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Qiwei Wang
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Xuedong Shi
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China,*Correspondence: Xuedong Shi, ; Mingxing Lei, ; Bailin Wang,
| | - Qianwen Ye
- Department of Oncology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Mingxing Lei
- Department of Orthopedic Surgery, Hainan Hospital of PLA General Hospital, Sanya, China,Chinese PLA Medical School, Beijing, China,*Correspondence: Xuedong Shi, ; Mingxing Lei, ; Bailin Wang,
| | - Bailin Wang
- Department of Thoracic Surgery, Hainan Hospital of PLA General Hospital, Sanya, China,*Correspondence: Xuedong Shi, ; Mingxing Lei, ; Bailin Wang,
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