This study aimed to develop a validated survival score for elderly patients with metastatic spinal cord compression (MSCC).
#Sequential testing ppv update#
Advances in local and systemic treatment significantly affect survival, therefore, it is necessary to update the survival indices used depending on the type and period of treatment. Prognostic tools have variable precision in determining the survival of BC patients with BM. The prognostic tools differed in their specific cut-off values. The majority of prognostic tools in BC patients with BM included: the performance status, the age at BM diagnosis, the number of BM (rarely the volume), the primary tumor phenotype/genotype and the extracranial metastasis status as a result of systemic therapy. Our criteria were limited to adults with newly diagnosed BM regardless of the presence or absence of any leptomeningeal metastases.ģ1 prognostic tools were selected: 13 analyzed mixed cohorts with some BC cases and 18 exclusively analyzed BC prognostic tools. We searched PubMed for prognostic tools concerning BC patients with BM, published from January 1997 (since the Radiation Therapy Oncology Group developed) to December 2021. Our review summarizes the current knowledge on this topic. Several prognostic tools for BC patients with BM have been proposed. In addition, validation is performed continuously as the data are collected.ĭetermining the proper therapy is challenging in breast cancer (BC) patients with brain metastases (BM) due to the variability of an individual's prognosis and the variety of treatment options available. Often the necessary number of patients can be reached within reasonable time frames even in small oncology practices. In-clinic validation of new predictive tools with sequential testing approach should be preferred over uncritical adoption of tools which provide no significant benefit to local patient populations. For the third score, no decision could be reached even after increasing the sample size to 30 (Figure 2). The positive predictive value (PPV) was used for validation of the respective score and it was required that the PPV exceeded 80%.įor two scores, validity in the own local patient population could be confirmed after entering 13 and 17 patients, respectively (Figures 1 and 3). For each scenario, a limited number of consecutive patients entered the sequential testing approach (Table 1). Three different scores were used, each predicting short overall survival after palliative radiotherapy (bone metastases, brain metastases, metastatic spinal cord compression). The present study evaluates this approach in scores related to radiation oncology. A recent article proposed an easy-to-use method for the in-clinic validation of new prediction tools with a limited number of patients, a so-called sequential testing approach. For practitioners, the question arises how their own patient population differs from that used in large-scale analyses resulting in new scores and nomograms and whether such tools actually are valid at a local level and thus can be implemented.