Abstract
BackgroundWe 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.MethodsWe 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).ResultsThe 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.ConclusionsPATHFx 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.
Highlights
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
Though PATHFx was designed using the records of patients with metastases of the appendicular and axial skeleton, the first external validation set lacked patients treated for axial lesions
Decision analysis revealed that PATHFx should be used, rather than assume all patients or no patients would survive longer than 12 months
Summary
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. Though most physicians are able to derive subjective survival estimates, they are generally inaccurate, and treating surgeons may be uncomfortable recording them in the medical record, or communicating them directly to patients [7] With this in mind, we developed a Bayesian Belief Network capable of estimating three and twelve month survival in patients undergoing surgery for skeletal metastases [8]. Additional validation studies are needed that include patients with both appendicular and axial metastases
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