{"doi":"10.1016/j.wneu.2023.02.064","title":"Can We Use Artificial Intelligence Cluster Analysis to Identify Patients with Metastatic Breast Cancer to the Spine at Highest Risk of Postoperative Adverse Events?","abstract":"Group patients who required open surgery for metastatic breast cancer to the spine by functional level and metastatic disease characteristics to identify factors that predispose to poor outcomes. A retrospective analysis included patients managed at 2 tertiary referral centers from 2008 to 2020. The primary outcome was a 90-day adverse event. A 2-step unsupervised cluster analysis stratified patients into cohorts using function at presentation, preoperative spine radiation, structural instability, epidural spinal cord compression (ESCC), neural deficits, and tumor location/hormone status. Comparisons were performed using χ2 test and one-way analysis of variance. Five patient “clusters” were identified. High function (HIGH) had thoracic metastases and an Eastern Cooperative Oncology Group (ECOG) score of 1.0 ± 0.8. Low function/irradiated (LOW + RADS) had preoperative radiation and the lowest Karnofsky scores (56.0 ± 10.6). Estrogen receptor or progesterone receptor (ER/PR) positive patients had >90% estrogen/progesterone positivity and moderate Karnofsky scores (74.0 ± 11.5). Lumbar/noncompressive (NON-COMP) had the fewest patients with ESCC grade 2 or 3 epidural disease (42.1%, P < 0.001). Low function/neurologic deficits (LOW + NEURO) had ESCC grade 2 or 3 disease and neurologic deficits. Adverse event rates were 25.0% in the HIGH group, 73.3% in LOW + RADS, 24.0% in ER/PR, 31.6% in NON-COMP, and 60.0% in LOW + NEURO (P = 0.003). Function at presentation, tumor hormone signature, radiation history, and epidural compression delineated postoperative trajectory. We believe our results can aid in expectation management and the identification of at-risk patients who may merit closer surveillance following surgical intervention.","journal":"World Neurosurgery","year":2023,"id":361760,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":8,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9342,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":649540,"name":"Layla Siraj","orcid":"0000-0002-3756-7495","position":1,"is_corresponding":false},{"id":924491,"name":"Julia B. Duvall","orcid":"0000-0002-0742-9139","position":2,"is_corresponding":false},{"id":1064720,"name":"Duncan C. Ramsey","orcid":"0000-0003-2058-9556","position":3,"is_corresponding":false},{"id":757068,"name":"Rafael De la Garza Ramos","orcid":"0000-0002-5536-2514","position":4,"is_corresponding":false},{"id":665820,"name":"Muhamed Hadzipasic","orcid":null,"position":5,"is_corresponding":false},{"id":698449,"name":"Ian D. Connolly","orcid":"0000-0002-5397-6344","position":6,"is_corresponding":false},{"id":517868,"name":"Theresa Williamson","orcid":"0000-0002-5036-8597","position":7,"is_corresponding":false},{"id":665821,"name":"Ganesh M. Shankar","orcid":null,"position":8,"is_corresponding":false},{"id":498741,"name":"Andrew J. Schoenfeld","orcid":"0000-0002-3691-1215","position":9,"is_corresponding":false},{"id":757072,"name":"Reza Yassari","orcid":"0000-0002-2593-2635","position":10,"is_corresponding":false},{"id":665364,"name":"Elie Massaad","orcid":"0000-0003-4883-914X","position":11,"is_corresponding":false},{"id":405,"name":"John H. Shin","orcid":"0000-0001-7490-8108","position":12,"is_corresponding":false},{"id":665366,"name":"Mitchell S. Fourman","orcid":"0000-0001-5886-546X","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T01:14:15.063476Z","pmid":"36805503","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}