論文種別	原著(症例報告除く)
言語種別	英語
査読の有無	その他(不明)
表題	Tree-based and sparse logistic models for predicting one-month postoperative performance status after surgery for spinal metastases.
掲載誌名	正式名：European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 略　 称：Eur Spine J ISSNコード：14320932/09406719
掲載区分	国外
巻・号・頁	pp.Online ahead of print
著者・共著者	Satoshi Maki, Yuki Shiratani, Sumihisa Orita, Akinobu Suzuki, Koji Tamai, Takaki Shimizu, Kenichiro Kakutani, Yutaro Kanda, Hiroyuki Tominaga, Ichiro Kawamura, Masayuki Ishihara, Masaaki Paku, Yohei Takahashi, Toru Funayama, Kousei Miura, Eiki Shirasawa, Hirokazu Inoue, Atsushi Kimura, Takuya Iimura, Hiroshi Moridaira, Hideaki Nakajima, Shuji Watanabe, Koji Akeda, Norihiko Takegami, Kazuo Nakanishi, Hirokatsu Sawada, Koji Matsumoto, Masahiro Funaba, Hidenori Suzuki, Haruki Funao, Tsutomu Oshigiri, Takashi Hirai, Bungo Otsuki, Kazu Kobayakawa, Koji Uotani, Hiroaki Manabe, Shinji Tanishima, Ko Hashimoto, Chizuo Iwai, Daisuke Yamabe, Akihiko Hiyama, Shoji Seki, Kenji Kato, Masashi Miyazaki, Kazuyuki Watanabe, Toshio Nakamae, Takashi Kaito, Hiroaki Nakashima, Narihito Nagoshi, Gen Inoue, Shiro Imagama, Kota Watanabe, Satoshi Kato, Seiji Ohtori, Takeo Furuya
発行年月	2026/05
概要	PURPOSE:We aimed to develop and internally validate prediction models for one-month postoperative performance status (PS) after surgery for spinal metastases and to identify patients likely to achieve PS 0-2 at one month.METHODS:We performed a retrospective analysis of a prospectively collected spine surgery registry. We compared three tree-based models (Random Forest, XGBoost, and CatBoost) with two regularized logistic regression models (ridge-regularized logistic regression and a sparse elastic-net logistic regression model constrained to ≤ 15 predictors). Model development and hyperparameter tuning were performed using nested cross-validation. Missing data were handled using model-specific strategies within the cross-validation pipeline, and a sensitivity analysis excluded the predictor with the highest missingness. Performance was assessed using discrimination and calibration metrics, including the area under the receiver operating characteristic curve (AUC-ROC), accuracy, precision, recall, F1 score, Brier score, calibration intercept, and calibration slope.RESULTS:The primary analysis included 375 patients with available one-month PS out of 413 enrolled patients. Random Forest achieved the highest discrimination (AUC-ROC 0.811 ± 0.079) and showed calibration measures closest to the ideal among the evaluated models (Brier score 0.168; calibration intercept - 0.024; slope 1.121). The sparse elastic-net model showed good discrimination (AUC-ROC 0.796 ± 0.081) with a limited set of predictors, although its calibration metrics suggested less reliable absolute probability estimates (Brier score 0.217; intercept 0.612; slope 3.228). Excluding the predictor with the highest missingness yielded similar performance for the main models.CONCLUSION:Tree-based models, particularly Random Forest, provided the most favorable overall predictive performance for one-month postoperative PS after surgery for spinal metastases, whereas a sparse elastic-net logistic regression model preserved reasonable discrimination with a small predictor set and coefficient-based interpretability. These findings support clinically oriented prediction of early postoperative functional status while highlighting the need to assess calibration before clinical implementation.
DOI	10.1007/s00586-026-09957-3
PMID	42207277