Can a Bayesian belief network for survival prediction in patients with extremity metastases (PATHFx) be externally validated in an Asian cohort of 356 surgically treated patients?

Hsiang Chieh Hsieh, Yi Hsiang Lai, Chia Che Lee, Hung Kuan Yen, Ting En Tseng, Jiun Jen Yang, Shin Yiing Lin, Ming Hsiao Hu, Chun Han Hou, Rong Sen Yang, Rikard Wedin, Jonathan A. Forsberg, Wei Hsin Lin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background and purpose — Predicted survival may influence the treatment decision for patients with skeletal extremity metastasis, and PATHFx was designed to predict the likelihood of a patient dying in the next 24 months. How-ever, the performance of prediction models could have eth-nogeographical variations. We asked if PATHFx generalized well to our Taiwanese cohort consisting of 356 surgically treated patients with extremity metastasis. Patients and methods — We included 356 patients who underwent surgery for skeletal extremity metastasis in a tertiary center in Taiwan between 2014 and 2019 to validate PATHFx’s survival predictions at 6 different time points. Model performance was assessed by concordance index (c-index), calibration analysis, decision curve analysis (DCA), Brier score, and model consistency (MC). Results — The c-indexes for the 1-, 3-, 6-, 12-, 18-, and 24-month survival estimations were 0.71, 0.66, 0.65, 0.69, 0.68, and 0.67, respectively. The calibration analysis demon-strated positive calibration intercepts for survival predictions at all 6 timepoints, indicating PATHFx tended to underesti-mate the actual survival. The Brier scores for the 6 models were all less than their respective null model’s. DCA demon-strated that only the 6-, 12-, 18-, and 24-month predictions appeared useful for clinical decision-making across a wide range of threshold probabilities. The MC was < 0.9 when the 6-and 12-month models were compared with the 12-month and 18-month models, respectively. Interpretation — In this Asian cohort, PATHFx’s performance was not as encouraging as those of prior validation studies. Clinicians should be cognizant of the potential decline in validity of any tools designed using data outside their particular patient population. Developers of survival prediction tools such as PATHFx might refine their algorithms using data from diverse, contemporary patients that is more reflective of the world’s population.

Original languageEnglish
Pages (from-to)721-731
Number of pages11
JournalActa Orthopaedica
Volume93
DOIs
StatePublished - 2022
Externally publishedYes

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