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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 5,
698-703.
doi: 10.1302/0301-620X.87B5.15185 Copyright © 2005 by British Editorial Society of Bone and Joint Surgery Prognostic factors and a scoring system for patients with skeletal metastasisH. Katagiri, MD, PhD, Senior Staff, Orthopaedic Surgeon; M. Takahashi, MD, PhD, Chief Orthopaedic Surgeon; K. Wakai, MD, PhD, Section Head, Epidemiologist; H. Sugiura, MD, PhD, Chief, Orthopaedic Surgeon; T. Kataoka, MD, PhD, Chief, Clinical Oncologist; and K. Nakanishi, MD, PhD, Chief, Orthopaedic SurgeonDivision of Orthopaedic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumicho, Sunto-gun, Shizuoka 411-8777, Japan, Division of Epidemiology and Prevention, Division of Orthopaedic Oncology, Aichi Cancer Center, 1-1, Kanokoden, Chikusa-ku, Nagoya-City 464-8681, Japan, Division of Clinical Oncology, Nagoya Memorial Hospital, 4-305 Hirabari, Tenpaku-ku, Nagoya-City 468-8520, Japan, Division of Orthopaedic Surgery, Prefectural Aichi Hospital, Kake-machi, Okazaki-City 444-0011, Japan. Correspondence should be sent to Dr H. Katagiri; e-mail: h.katagiri{at}scchr.jp
Between 1992 and 1999, we treated 350 patients with skeletal metastases. A multivariable analysis of the patients was conducted using the Cox proportional hazards model. We identified five significant prognostic factors for survival, namely, the site of the primary lesion, the performance status (Eastern Cooperative Oncology Group status 3 or 4), the presence of visceral or cerebral metastases, any previous chemotherapy, and multiple skeletal metastases. The score for each significant factor was derived from the corresponding estimated regression coefficients (natural logarithm of the hazard ratio). The prognostic score was calculated by adding all the scores for individual factors. The rate of survival was 31% at six months and 11% at one year for the patients with a prognostic score of 6 or more. By contrast, patients with a prognostic score of 2 or less had a rate of survival of 98% at six months and 89% at one year. This scoring system can be used to determine the optimal treatment for patients with pathological fractures or epidural compression.
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