New prognostic factors and scoring system for patients with skeletal metastasis

Abstract

The aim of this study was to update a previous scoring system for patients with skeletal metastases, that was proposed by Katagiri et al. in 2005, by introducing a new factor (laboratory data) and analyzing a new patient cohort. Between January 2005 and January 2008, we treated 808 patients with symptomatic skeletal metastases. They were prospectively registered regardless of their treatments, and the last follow-up evaluation was performed in 2012. There were 441 male and 367 female patients with a median age of 64 years. Of these patients, 749 were treated nonsurgically while the remaining 59 underwent surgery for skeletal metastasis. A multivariate analysis was conducted using the Cox proportional hazards model. We identified six significant prognostic factors for survival, namely, the primary lesion, visceral or cerebral metastases, abnormal laboratory data, poor performance status, previous chemotherapy, and multiple skeletal metastases. The first three factors had a larger impact than the remaining three. The prognostic score was calculated by adding together all the scores for individual factors. With a prognostic score of ≥7, the survival rate was 27% at 6 months, and only 6% at 1 year. In contrast, patients with a prognostic score of ≤3 had a survival rate of 91% at 1 year, and 78% at 2 years. Comparing the revised system with the previous one, there was a significantly lower number of wrongly predicted patients using the revised system. This revised scoring system was able to predict the survival rates of patients with skeletal metastases more accurately than the previous system and may be useful for selecting an optimal treatment.

Classification and scoring systems for metastatic spine tumors: a literature review

“…It was derived retrospectively Figure 4. Prognostic factors that were adopted by the 22 scoring systems 6,11,12,14,[42][43][44][45][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] . 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 articles Table 10.…”

“…0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 articles Table 10. Katagiri New Score (2014) 54) .…”

“…However, as the survival period of patients has been prolonged recently owing to improvements in adjuvant therapies, such as molecularly targeted drugs, the history of chemotherapy has become an important prognostic factor. Katagiri et al also reported a new scoring system with modifications of score allocation for breast and prostate cancers according to hormone dependence or independence of the primary lesions and for lung cancer according to the use or non use of molecular targeted drugs and incorporation of laboratory data (Table 10, 2014) 54) . In a series of 808 patients, the 2-year survival rate was reported to be 77.8% in a group with a total score of 0-3, the 1-year survival rate was 49.3%, and the 6-month survival rate was 74.0%, in a group with a total score of 4-6, and the 6-month survival rate was 26.9% in a group with a total score of 7-10.…”

Paradigmaváltás a csontmetasztázisok sebészetében. I. Végtagi és medencelokalizációjú áttétek

“…A legtöbb szerző szerint jelenleg is a primer tumor jellege a legerősebb prognosztikai faktor, így myeloma, lymphoma, emlő-és vesecarcinomák esetén lényegesen jobbak az életkilátások, szemben a tüdő-, prostatarákkal, melanomával vagy ha ismeretlen a primer tumor [8,9]. Nagy beteganyagon vizsgált Cox-regressziós analízissel igazolt további prognosztikai faktorok közül kiemelendő a betegek általános állapotát jellemző Karnofsky/ECOG (Eastern Cooperative Oncology Group) index, a betegek műtét előtti anaemiája (hemoglobinérték 7 mmol/l alatt vagy felett), a metasztázisok száma a csontrendszerben (szoliter versus multiplex), egyidejű visceralis/agyi áttétek jelenléte [8][9][10]. Megoszlanak a vélemények a patológiás törést mint prognosztikai faktort illetően.…”

“…Több munkacsoport [3,9,23] megpróbált a prognosztikai faktorokra alapozva olyan pontozásos rendszert kidolgozni, amelynek segítségével megjósolható a betegek túlélési esélye. Mindamellett a sok egyedi eltérés miatt igen nehéz megjósolni a betegek túlélését esetenként hónapokra, évekre vonatkoztatva [24].…”