A systematic review and meta-analysis of the predictive accuracy of preoperative scoring systems for postoperative survival in patients with metastatic bone disease

One significant clinical challenge is meeting the needs of patients with metastatic bone disease (MBD) who are susceptible to pathological fractures. Patients with cancer who undergo surgical procedures are more vulnerable to thromboembolic and infectious complications. The expected survival rate plays a major role in deciding the best action. The current systematic review and meta-analysis were conducted to evaluate the validity and reliability of various preoperative survival scores in surgery for MBD. The aim of the review was to examine the preoperative survival evaluations used in surgery for MBD. A comprehensive exploration of medical literature was conducted using MEDLINE (accessed through Ovid), EMBASE (accessed through Ovid), and PubMed. A systematic analysis of studies examining prognostic scores that gauged survival rates in individuals with bone metastases was performed. Additionally, a meta-analysis encompassed studies assessing the sensitivity and specificity of the Tokuhashi and Tomita scores in predicting 6-month survival rates for spinal metastases. Incorporating a total of 68 studies, with 35 included in the meta-analysis, the Tokuhashi score demonstrated sensitivities ranging from 27 to 92%, and the Tomita score exhibited sensitivities from 76 to 99%. Specificities for the Tokuhashi score ranged from 44 to 96%, while the Tomita score specificities varied from 1 to 44%. The pooled diagnostic odds ratio was 6.04 (95% confidence interval, 3.96–9.21; Tau-squared=0.90; I=86%) for the Tokuhashi score and 1.34 (95% confidence interval, 0.67–2.67; Tau-squared=1.02; I=85%) for the Tomita score. The SORG Nomogram, developed in a substantial surgical cohort, exhibited robust discrimination for 3-month and 1-year survival, reliable calibration, and outperformed counterparts with low risk of bias and applicability concerns. PATHFx 3.0, 2013-SPRING, and potentially Optimodel emerged as superior models for predicting survival in extremity metastasis surgery. The Tokuhashi score showed high sensitivity and specificity, with an overall higher diagnostic value compared to the Tomita score. The SORG Nomogram demonstrated robust performance in predicting 3-month and 1-year survival, surpassing other models in terms of reliability and applicability. Additionally, PATHFx 3.0, 2013-SPRING, and potentially Optimodel emerged as promising models for predicting survival in extremity metastasis surgery.