Background: Performance status is often cited as an independent predictor of survival after metastatic spine tumor surgery (MSTS), but its standalone predictive value for short-term outcomes remains unclear. We aimed to evaluate how well Karnofsky (KPS) and Eastern Cooperative Oncology Group performance status (ECOG-PS) predict 90-day survival, a common surgical candidacy threshold, in patients managed with MSTS. Methods: We conducted a retrospective study of 175 adult patients who underwent MSTS at a single institution (2012–2025). All patients had documented preoperative KPS and ECOG-PS scores. Univariable logistic regression was used to assess associations with 90-day survival. Predictive performance was assessed by discrimination (AUC), diagnostic accuracy, calibration (Brier score), and clinical utility (decision curve analysis). Results: The crude 90-day survival rate was 73%. Both KPS (OR 1.02 [95% CI 1.01 to 1.05];p= 0.001) and ECOG-PS (OR 0.51 [95% CI 0.36 to 0.73];p< 0.001) were statistically associated with survival. However, discrimination was modest (AUC 0.65 for KPS, 0.68 for ECOG-PS), with the most balanced diagnostic accuracy achieved at KPS ≥ 70 (sensitivity 0.66, specificity 0.62) and ECOG-PS ≤ 2 (sensitivity 0.76, specificity 0.5). Calibration was fair (Brier scores 0.185 and 0.182, respectively). Decision curve analysis showed minimal net benefit across most threshold probabilities, with ECOG-PS performing slightly better at intermediate thresholds (30–60%), the zone of greatest clinical uncertainty. Conclusions: Despite being widely cited as an independent predictor of postoperative survival in patients with metastatic spine disease, performance status assessed via the KPS and ECOG-PS demonstrated only modest overall discriminatory ability, diagnostic accuracy, calibration, and clinical utility when used alone to predict 90-day survival after MSTS. While both scores retained meaningful value at the extremes (i.e., patients with very poor or very good performance status had more predictable outcomes), caution is warranted in intermediate cases, where performance status alone may be insufficient to guide treatment decisions. These findings highlight the critical difference between statistical association and the real-world clinical utility of a single metric to predict outcome in this patient population.
背景：体能状态常被视为转移性脊柱肿瘤手术（MSTS）后生存期的独立预测因子，但其对短期结局的独立预测价值尚不明确。本研究旨在评估卡氏功能状态评分（KPS）和东部肿瘤协作组体能状态评分（ECOG-PS）对接受MSTS治疗患者90天生存期的预测效能，该时间点是常见的手术适应症筛选阈值。 方法：我们对2012年至2025年间在同一机构接受MSTS的175例成年患者进行了回顾性研究。所有患者均有术前记录的KPS和ECOG-PS评分。采用单变量逻辑回归分析评估其与90天生存期的关联。通过区分度（AUC）、诊断准确性、校准度（Brier评分）和临床实用性（决策曲线分析）评估预测性能。 结果：粗算90天生存率为73%。KPS（OR 1.02 [95% CI 1.01至1.05]；p=0.001）和ECOG-PS（OR 0.51 [95% CI 0.36至0.73]；p<0.001）均与生存期存在统计学关联。然而，区分度一般（KPS的AUC为0.65，ECOG-PS为0.68），诊断准确性在KPS ≥ 70（敏感性0.66，特异性0.62）和ECOG-PS ≤ 2（敏感性0.76，特异性0.5）时达到最佳平衡。校准度尚可（Brier评分分别为0.185和0.182）。决策曲线分析显示，在大多数阈值概率下净获益极小，其中ECOG-PS在中等阈值（30–60%）——即临床不确定性最大的区间——表现略优。 结论：尽管KPS和ECOG-PS体能状态评分被广泛认为是转移性脊柱疾病患者术后生存期的独立预测因子，但当单独用于预测MSTS后90天生存期时，其总体区分能力、诊断准确性、校准度和临床实用性均表现一般。虽然两种评分在极端情况下（即体能状态极差或极佳的患者结局更可预测）仍具有重要价值，但对于中等体能状态患者需谨慎，仅凭体能状态可能不足以指导治疗决策。这些发现凸显了统计学关联与单一指标预测该患者群体结局的实际临床实用性之间的关键差异。
肿瘤(癌症)患者之家