• Laurens Bollen, Christine Wibmer, Yvette M Van der Linden, Willem Pondaag, Marta Fiocco, Wilco C Peul, Corrie A M Marijnen, Rob G H H Nelissen, Andreas Leithner, and Sander P D Dijkstra.
• *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.
• Spine. 2016 Feb 1; 41 (3): E155-62.

Study DesignA retrospective cohort study.ObjectiveThe 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).Summary Of Background DataOn 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.MethodsAll 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.ResultsMedian 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.ConclusionThe Bollen model performs better than the other models. However, improvements are still warranted to increase the accuracy.Level Of Evidence3.

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