TY - JOUR
T1 - How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations
AU - Piccioli, Andrea
AU - Spinelli, M. Andrea
AU - Forsberg, Jonathan A.
AU - Wedin, Rikard
AU - Healey, John H.
AU - Ippolito, Vincenzo
AU - Daolio, Primo Andrea
AU - Ruggieri, Pietro
AU - Maccauro, Giulio
AU - Gasbarrini, Alessandro
AU - Biagini, Roberto
AU - Piana, Raimondo
AU - Fazioli, Flavio
AU - Luzzati, Alessandro
AU - Di Martino, Alberto
AU - Nicolosi, Francesco
AU - Camnasio, Francesco
AU - Rosa, Michele Attilio
AU - Campanacci, Domenico Andrea
AU - Denaro, Vincenzo
AU - Capanna, Rodolfo
N1 - Publisher Copyright:
© 2015 Piccioli et al.; licensee BioMed Central.
PY - 2015/5/22
Y1 - 2015/5/22
N2 - Background: We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.org, we attempted to externally validate it using independent, international data. Methods: We collected data from patients treated at 13 Italian orthopaedic oncology referral centers between 2010 and 2013, then applied to PATHFx, which generated a probability of survival at three and 12-months for each patient. We assessed accuracy using the area under the receiver-operating characteristic curve (AUC), clinical utility using Decision Curve Analysis (DCA), and compared the Italian patient data to the training set (United States) and first external validation set (Scandinavia). Results: The Italian dataset contained 287 records with at least 12 months follow-up information. The AUCs for the three-month and 12-month estimates was 0.80 and 0.77, respectively. There were missing data, including the surgeon's estimate of survival that was missing in the majority of records. Physiologically, Italian patients were similar to patients in the training and first validation sets. However notable differences were observed in the proportion of those surviving three and 12-months, suggesting differences in referral patterns and perhaps indications for surgery. Conclusions: PATHFx was successfully validated in an Italian dataset containing missing data. This study demonstrates its broad applicability to European patients, even in centers with differing treatment philosophies from those previously studied.
AB - Background: We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.org, we attempted to externally validate it using independent, international data. Methods: We collected data from patients treated at 13 Italian orthopaedic oncology referral centers between 2010 and 2013, then applied to PATHFx, which generated a probability of survival at three and 12-months for each patient. We assessed accuracy using the area under the receiver-operating characteristic curve (AUC), clinical utility using Decision Curve Analysis (DCA), and compared the Italian patient data to the training set (United States) and first external validation set (Scandinavia). Results: The Italian dataset contained 287 records with at least 12 months follow-up information. The AUCs for the three-month and 12-month estimates was 0.80 and 0.77, respectively. There were missing data, including the surgeon's estimate of survival that was missing in the majority of records. Physiologically, Italian patients were similar to patients in the training and first validation sets. However notable differences were observed in the proportion of those surviving three and 12-months, suggesting differences in referral patterns and perhaps indications for surgery. Conclusions: PATHFx was successfully validated in an Italian dataset containing missing data. This study demonstrates its broad applicability to European patients, even in centers with differing treatment philosophies from those previously studied.
KW - Bayesian statistics
KW - Postoperative survival
KW - Prognostic model
KW - Skeletal metastasis
UR - http://www.scopus.com/inward/record.url?scp=84930204668&partnerID=8YFLogxK
U2 - 10.1186/s12885-015-1396-5
DO - 10.1186/s12885-015-1396-5
M3 - Article
C2 - 25998535
AN - SCOPUS:84930204668
SN - 1471-2407
VL - 15
JO - BMC Cancer
JF - BMC Cancer
IS - 1
M1 - 424
ER -