Prognostic factors in patients with metastatic spine tumors derived from lung cancer—a novel scoring system for predicting life expectancy

Abstract

BackgroundRecently, molecule-targeting and bone-modifying agents have improved the treatment outcomes of lung cancer-derived metastatic spine tumors. Therefore, the prognostic factors for such tumors were examined, and novel scoring systems for predicting the life expectancy of patients with such tumors were proposed.MethodsIn 207 patients with lung cancer-derived metastatic spine tumors (surgery 49; conservative therapy 158), we retrospectively examined the factors that influenced the post-treatment survival time (age, sex, the affected site, pathology, general condition, the number of extraspinal bone metastases, the number of spinal metastases, the presence/absence of major internal organ metastasis, paralysis state, the total Tokuhashi score, the serum alkaline phosphatase level, the serum carcinoembryonic antigen level, molecule-targeting drug treatment, and bone-modifying agent treatment). Based on the results, we devised novel scoring systems for predicting the prognosis of such patients.ResultsUnivariate analyses showed that the pathology of the primary lung tumor, the patient’s general condition and paralysis state, and the presence/absence of molecule-targeting drug treatment significantly influenced survival. We performed a Cox regression analysis of these four factors and developed criteria for a novel scoring system based on the patient’s general condition and paralysis state, which exhibited significance in the regression analysis. A retrospective review indicated that the consistency rate between predicted life expectancy and actual survival was 67.3%. When criteria based on the four factors that exhibited significance in the univariate analyses were adopted, the consistency rate was 76.2%.ConclusionThe patient’s general condition and paralysis state, the pathology of the primary lung tumor, and molecule-targeting drug treatment influenced survival among patients with lung cancer-derived metastatic spine tumors. Novel scoring systems based on these four factors were proposed.

Overall survival nomogram for patients with spinal bone metastases (SBM)

“…Renowned prognostic scoring systems (Bauer, Tokuhashi, Tomita, van der Linden, Sioutos, Katagiri, and NESMS) have been developed to assist clinicians and care providers in determining the survival prognosis of metastatic spine tumor patients for an optimal therapeutic choice [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] . In contrast to this study, none of these scoring systems include demographic features such as age and sex.…”

Prediction of post-radiotherapy survival for bone metastases: a comparison of the 3-variable number of risk factors model with the new Katagiri scoring system

“…found that previous chemotherapy was a significant prognostic factor [ 13 ], but was the sole non-significant factor per our multivariate analyses ( Table 2 ). A few studies found that treatment with molecularly targeted drugs is an important predictor of prognosis in patients with bone metastases arising from lung cancer [ 28 , 29 ]. The Katagiri score variable ‘primary tumor growth’ also evaluates whether lung cancer can be treated with molecularly targeted drugs.…”

Research on the predicting power of the revised Tokuhashi system: how much time can surgery give to patients with short life expectancy?

“…Even more prognosispredicting scoring systems appear in the literature which focus on metastases caused by one type of primary tumor (so we can get more precise prediction based on more specific information, e.g., histological categorization, molecular subtypes, specific targeted treatment options, etc.). Uei et al [27] designed a new system for estimating the outcome of spinal metastasis in patients with primary lung cancer, which also takes into account the possibility of tumor antigens and molecular target therapy.…”