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The 'Rizzoli Score': An Easy Prognostic Score for Survival Estimation for Patients with Symptomatic Long Bone Metastases
23 Pages Posted: 22 Jul 2020
More...Abstract
Background: Surgical options for long bone metastases include intramedullary nail fixation or prosthetic reconstruction. Patients with a short life expectancy may benefit from less invasive surgery such as intramedullary nail fixation, while patients with a long life expectancy could be treated with more invasive surgery such as prosthetic reconstruction. Thus, life expectancy at 12 months seems to be the most important factor in determining the surgical treatment modality in patients with a metastatic bone disease.
Methods: We investigated prospectively potentially clinical and laboratory prognostic factors in 173 patients with metastatic bone disease who underwent surgery with intramedullary nail fixation or prosthetic reconstruction. Clinical data were collected, recording the following data: age, sex and Karnofsky performance of patients, primary tumor and time of diagnosis, skeletal location and numbers of bone metastases, presence of visceral metastases. The following laboratory data were analyzed: hemoglobin, leukocyte counts, lymphocyte counts, platelets count, alkaline phosphatase and C-reactive protein.
Findings: Our study showed that pathological C-reactive protein and primary tumor diagnosis were significant negative independent prognostic factors at 12-month survival. Based on our results, we created a score using C-reactive Protein and primary tumor diagnosis, creating three different prognostic groups: (A) good prognosis primary tumor and physiological C-reactive protein; (B) bad prognosis primary tumor and physiological C-reactive protein or good prognosis primary tumor and pathological C-reactive protein; (C) bad prognosis primary tumor and pathological C-reactive protein. Our prognostic score, named the Rizzoli Score, was able to predict the 12-month survival of patients with metastatic bone disease and could be helpful in choosing the best treatment for patients with symptomatic long bone metastases.
Interpretation: The results of our study may be utilized by general orthopaedic surgeons in every community hospital to improve decision-making in the care of patients with long bone metastases, avoiding over- or under-treatment.
Trial Registration: ClinicalTrials.gov (identifier NCT03188926).
Funding: None
Declaration of Interests: All authors declare no conflict of interest.
Ethics Approval Statement: An independent ethics committee approved the study.
Keywords: cancer, bone metastases, prognosis, treatment, survival
Suggested Citation: Suggested Citation