| 1. |
- Carrwik, Christian, et al.
(författare)
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Predicting survival of patients with spinal metastatic disease using PathFx 3.0 – A validation study of 668 patients in Sweden
- 2022
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Ingår i: Brain and Spine. - : Elsevier BV. - 2772-5294. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction PathFx is a computer-based prediction model for estimating survival of patients with bone metastasis. The model has been validated in several studies, but this is the first validation using exclusively patients with spinal metastases. Research question Is PathFx 3.0 a tool useful for predicting survival for patients with spinal metastatic disease? Material and methods 668 patients (67% male, median age 67 years) presenting with spinal metastases at two university hospitals in Sweden 1991–2014 were included. Of those, the majority (82%, n=551) underwent surgery. Data on all patients was analyzed with PathFx version 3.0, generating a probability of survival at 1, 3, 6, 12, 18 and 24 months. The predictions were compared to real survival data and the precision in estimation was evaluated with Receiver-Operating Characteristic curve (ROC) analysis where the Area Under Curve (AUC) was calculated. Brier score and decision curve analyses were also assessed. Results The AUC for 1-, 3-, 6- and 12 months survival predictions were 0.64 (95% CI 0.5–0.71), 0.71 (95% CI 0.67–0.75), 0.70 (95% CI 0.66–0.77) and 0.74 (95% CI 0.70–0.78). For 18- and 24 months survival the AUC were 0.74 (95% CI 0.69–0.78) and 0.76 (95% CI 0.72–0.81). The Brier scores were all 0.23 or lower depending on the estimated survival time. Discussion and conclusion PathFx 3.0 is a reasonably reliable tool for predicting survival in patients with spinal metastatic disease. As the PathFx computer model can be updated to reflect advancements in oncology, we suggest this type of model, rather than rigid point-based scoring systems, to be used for estimating survival in patients with metastatic spinal disease in the future.
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| 2. |
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| 3. |
- Hansen, Bjarne H, et al.
(författare)
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The Scandinavian Sarcoma Group Skeletal Metastasis Registry Functional outcome and pain after surgery for bone metastases in the pelvis and extremities
- 2009
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Ingår i: ACTA ORTHOPAEDICA. - : Medical Journals Sweden AB. - 1745-3674 .- 1745-3682. ; 80, s. 85-90
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Tidskriftsartikel (refereegranskat)abstract
- Background Few authors have investigated function and pain after surgical treatment of patients with bone metastases. In 1999 the Scandinavian Sarcoma Group (SSG) initiated the Skeletal Metastasis Registry as a multi-centric, prospective study to provide a scientific basis for recommendations of treatment. Patients and methods We have analyzed function and pain in 530 patients (mean age 65 yr) operated on (599 operations) for non-spinal skeletal metastases at 9 SSG centres. 7% were operated for more than 1 metastasis. Carcinoma of the breast, prostate, kidney, and lung were the dominating sites for primary tumors. Results 25% of the patients died within 6 weeks after operation. 11% of the patients had complications. 6% had reoperation. In patients surviving more than 1 year the reoperation rate was 12%. 92% of the patients had no, light or moderate pain from metastasis at 6 weeks (first control) and 6 months follow-up. Patients using opioids were reduced from 40% preoperative to 30% at 6 months after surgery. In patients with metastases in pelvis or lower extremity 79% were walking with or without crutches, 6 weeks and 88%, 6 months after surgery. More patients with metastases; in proximal femur were mobile at 6 weeks and 6 months when treated with prosthetic replacement compared to internal fixation. Interpretation Palliative surgery for bone metastases improves function and reduce pain. Mobility is improved by surgery in patients with metastases in the pelvis or lower extremity. Prosthetic replacement seems to do better than internal fixation for metastases in the proximal femur. We need to analyze function and pain earlier than 6 weeks postoperative to investigate the benefit of surgery in patients with short time survival.
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| 4. |
- Hensvold, Aase, et al.
(författare)
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The human bone marrow plasma cell compartment in rheumatoid arthritis-Clonal relationships and anti-citrulline autoantibody producing cells
- 2023
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Ingår i: Journal of Autoimmunity. - : Elsevier BV. - 0896-8411 .- 1095-9157. ; 136
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Tidskriftsartikel (refereegranskat)abstract
- A majority of circulating IgG is produced by plasma cells residing in the bone marrow (BM). Long-lived BM plasma cells constitute our humoral immune memory and are essential for infection-specific immunity. They may also provide a reservoir of potentially pathogenic autoantibodies, including rheumatoid arthritis (RA)-associated anti-citrullinated protein autoantibodies (ACPA). Here we investigated paired human BM plasma cell and peripheral blood (PB) B-cell repertoires in seropositive RA, four ACPA+ RA patients and one ACPA- using two different single-cell approaches, flow cytometry sorting, and transcriptomics, followed by recombinant antibody generation. Immunoglobulin (Ig) analysis of >900 paired heavy-light chains from BM plasma cells identified by either surface CD138 expression or transcriptome profiles (including gene expression of MZB1, JCHAIN and XBP1) demonstrated differences in IgG/A repertoires and N-linked glycosylation between patients. For three patients, we identified clonotypes shared between BM plasma cells and PB memory B cells. Notably, four individuals displayed plasma cells with identical heavy chains but different light chains, which may indicate receptor revision or clonal convergence. ACPA-producing BM plasma cells were identified in two ACPA+ patients. Three of 44 recombinantly expressed monoclonal antibodies from ACPA+ RA BM plasma cells were CCP2+, specifically binding to citrullinated peptides. Out of these, two clones reacted with citrullinated histone-4 and activated neutrophils. In conclusion, single-cell investigation of B-cell repertoires in RA bone marrow provided new understanding of human plasma cells clonal relationships and demonstrated pathogenically relevant disease-associated autoantibody expression in long-lived plasma cells.
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| 5. |
- Ratasvuori, Maire, et al.
(författare)
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Insight opinion to surgically treated metastatic bone disease: Scandinavian Sarcoma Group Skeletal Metastasis Registry report of 1195 operated skeletal metastasis
- 2013
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Ingår i: Surgical Oncology. - : Elsevier BV. - 0960-7404 .- 1879-3320. ; 22:2, s. 132-138
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Forskningsöversikt (refereegranskat)abstract
- The number of cancer patients living with metastatic disease is growing. The increased survival has led to an increase in the number of cancer-induced complications, such as pathologic fractures due to bone metastases. Surgery is most commonly needed for mechanical complications, such as fractures and intractable pain. We determined survival, disease free interval and complications in surgically treated bone metastasis. Data were collected from the Scandinavian Skeletal Metastasis Registry for patients with extremity skeletal metastases surgically treated at eight major Scandinavian referral centres between 1999 and 2009 covering a total of 1195 skeletal metastases in 1107 patients. Primary breast, prostate, renal, lung, and myeloma tumors make up 78% of the tumors. Number of complications is tolerable and is affected by methods of surgery as well as preoperative radiation therapy. Overall 1-year patient survival was 36%; however, mean survival was influenced by the primary tumor type and the presence of additional visceral metastases. Patients with impending fracture had more systemic complications than those with complete fracture. Although surgery is usually only a palliative treatment, patients can survive for years after surgery. We developed a simple, useful and reliable scoring system to predict survival among these patients. This scoring system gives good aid in predicting the prognosis when selecting the surgical method. While it is important to avoid unnecessary operations, operating when necessary can provide benefit. (C) 2013 Elsevier Ltd. All rights reserved.
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| 6. |
- Ratasvuori, Maire, et al.
(författare)
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Prognostic role of en-bloc resection and late onset of bone metastasis in patients with bone-seeking carcinomas of the kidney, breast, lung, and prostate: SSG study on 672 operated skeletal metastases
- 2014
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Ingår i: Journal of Surgical Oncology. - : Wiley-Blackwell. - 0022-4790 .- 1096-9098. ; 110:4, s. 360-365
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives In metastatic disease, decisions regarding potential surgery require reliable data about the patients survival. In this study, we evaluated different prognostic factors and their impact in four common primary tumors causing bone metastases. Methods Data were acquired from the Scandinavian Sarcoma Group (SSG) metastasis registry. The patients underwent surgery between July 1999 and July 2009. This study included breast, prostate, lung, and kidney cancer cases, with a total of 672 operated non-spinal metastases. Differences in prognostic factors were evaluated using the Kaplan-Meier method with long-rank test. Cox regression multivariate analysis was performed to identify statistically independent prognostic factors. Results Significant factors affecting survival were the presence of organ metastases, overall heath status, and disease load. In kidney cancer, en bloc resection of solitary metastases was associated with a significant fourfold longer survival compared to intralesional surgery. Preoperative radiotherapy was associated with higher complication and reoperation rates. Conclusions This data summary is important tool for clinicians to evaluate survival and choose treatment options for patients suffering from metastatic bone disease. J. Surg. Oncol. 2014; 110:360-365.
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| 7. |
- Wedin, Rikard, et al.
(författare)
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Complications and survival after surgical treatment of 214 metastatic lesions of the humerus
- 2012
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Ingår i: Journal of Shoulder and Elbow Surgery. - : Elsevier BV. - 1058-2746 .- 1532-6500. ; 21:8, s. 1049-1055
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Tidskriftsartikel (refereegranskat)abstract
- Background: The humerus is the second most common long-bone site of metastatic bone disease. We report complications, risk factors for failure, and survival of a large series of patients operated on for skeletal metastases of the humerus. Materials and methods: This study was based on 208 patients treated surgically for 214 metastatic lesions of the humerus. Reconstructions were achieved by intramedullary nails in 148, endoprostheses in 35, plate fixation in 21, and by other methods in 10. Results: The median age at surgery was 67 years (range, 29-87 years). Breast cancer was the primary tumor in 31%. The overall failure rate of the surgical reconstructions was 9%. The reoperation rate was 7% in the proximal humerus, 8% in the diaphysis, and 33% in the distal part of the bone. Among 36 operations involving an endoprosthesis, 2 were failures (6%) compared with 18 of 178 osteosynthetic devices (10%). In the osteosynthesis group, intramedullary nails failed in 7% and plate fixation failed in 22%. Multivariate Cox regression analysis showed that prostate cancer was associated with an increased risk of failure after surgery (hazard ratio, 7; P < 0.033). The cumulative survival after surgery was 40% (95% confidence interval [CI] 34-47) at 1 year, 21% (95% CI, 15-26) at 2 years, and 16% (95% CI, 12-19) at 3 years. Conclusions: Our method of choice is the cemented hemiprosthesis for pathologic proximal humeral fractures and interlocked intramedullary nail for lesions in the diaphysis. Pathologic fractures in the distal humerus are uncommon and associated with a very high reoperation rate. Level of evidence: Level IV, Case Series, Treatment Study. (C) 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
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| 8. |
- Wedin, Rikard
(författare)
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Metastatic bone disease
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To evaluate epidemiology, prognosis and diagnostics in metastatic bone disease and identify risk factors for failure after operation for pathologic fracture. Patients: The study was based on patients treated for skeletal metastases, myeloma or lymphoma between 1986 and 1998 at the Oncology Service, Department of Orthopedics, Karolinska Hospital and on patients diagnosed with symptomatic skeletal metastases 1989-1994 in the Stockholm Region. Epidemiology: 641 breast cancer patients were diagnosed with symptomatic skeletal metastases 1989-1994. Based upon 1100 new primary breast cancer cases yearly, the overall risk of developing symptomatic skeletal metastases was 10-15%. One out of 5 patients with skeletal metastases required surgical treatment for skeletal complications. Prognosis: The survival rate after surgical treatment for skeletal complications was 0.3 at 1 year and 0.008 at 3 years. Multivariate analysis based on 619 patients showed that complete pathologic fracture and soft tissue metastases were negative prognostic variables for 1-year survival after operation. Solitary skeletal metastasis, breast, prostate, kidney cancer, myeloma and lymphoma were positive variables. Immunohistochemistry was used to analyze ER, PgR, MIB and p53 in 43 primary breast carcinomas and their skeletal metastases. PgR and p53 may provide prognostic information after pathologic fracture and not only at diagnosis of the primary tumor. Diagnosis: Fine Needle Aspiration Biopsy ((FNAB) was assessed in 110 patients for diagnostic accuracy and to which extent information about primary site of the metastatic carcinoma could be gained. There were 80 patients with metastatic carcinoma, 14 with lymphoma, and 16 with myeloma. FNAB offered correct diagnosis in 9 of 10 patients an also provided guidance in the search for the primary lesions. Hence, 27 of 30 myeloma or lymphomas were diagnosed by FNAB and in half of the patients with metastatic carcinoma the site of the primary tumor could be ascertained. For patients with a suspected skeletal metastasis the search for the primary tumor may preferably start with FNAB. Surgical treatment: Risk factors for failure after operation for pathologic fractures were identified in 192 patients treated for 228 metastatic lesions of the long bones. 26 out of 22 procedures (11 %) lead to failures necessitating reoperation. Long survival after surgery was the most important risk factor for failure of the reconstruction. Kidney cancer was the primary tumor associated with the highest rate of reoperations. Reconstructions based on prosthetic a opposed to osteosynthetic devices appeared safer. There was a tendency for a high reoperation rate in hospitals with few treated patients. Conclusion: To decrease the risk of reoperation, it is important to identify patients with a long expected survival. In patients with a good prognosis, wide resection and reconstruction as applied in primary malignant bone tumors should be considered.
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