Predicting survival for metastatic spine disease: a comparison of nine scoring systems

Ahmed, Ali; Goodwin, C. Rory; Heravi, Amir S.; Kim, Rachel C.; Abu-Bonsrah, Nancy; Sankey, Eric W.; Kerekes, Daniel; Ramos, Rafael De la Garza; Schwab, Joseph H.; Sciubba, Daniel M.

doi:10.1016/j.spinee.2018.03.011

Cited by 102 publications

(71 citation statements)

References 43 publications

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“…The results for clinical indicators were similar to those of other studies. In this study, 73.33% of patients had no clear history of primary tumors when diagnosed with spinal metastases, and most of them saw a doctor because of local pain or MSCC.…”

Section: Discussionsupporting

confidence: 90%

Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study

Feng

Zhang

Yang

et al. 2019

Orthopaedic Surgery

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Objectives: To describe the epidemiological characteristics of patients with spinal metastases between 2007 and 2019. Methods: Patients with spinal metastases were identified from several clinical centers in China between January 2007 and July 2019. Demographics, primary tumor types, spinal involvement, and Clinical indicators of each patient were reviewed.Results: A total of 1196 patients were included in this study, 717 males (59.95%) and 479 females (40.05%), with a male to female ratio of 1.50:1. Most patients (63.71%) were in the ages range of 50 to 69 years. The mean age was 58.6 AE 11.6 (range 13-89) years and the median age was 59.0 years. The average age of females was younger than that of males, and the difference was statistically significant. The proportion of male patients over 60 years old was higher than that of females, and the difference was statistically significant. The most common primary tumor was lung cancer (n = 437, 36.54%), followed by unknown origin (n = 194, 16.22%), kidney cancer (n = 78, 6.52%), breast cancer (n = 76, 6.35%), and liver/biliary cancer (n = 75, 6.27%). The most common primary tumor was lung cancer in both males and females, followed by unknown origin in males and breast cancer in females. There were 730 patients (61.04%) in the subgroup of the number<3; the highest level was lumbar vertebrae, with 250 patients (34.25%). The remaining 466 patients (38.96%) were included in the subgroup of the number ≥ 3; the highest level was tumor metastasis of multiple-level of spine, with 334 patients (71.67%). Among the 1196 patients, spinal cord injury occurred in 54.01% of patients, 76.34% of patients developed moderate and above pain, 55.69% of patients had metastatic spinal cord compression, and only 26.67% of patients had a clear history of primary tumors. Conclusion:This study provided a relatively detailed description of epidemiological characteristics in spinal metastases in China, which could assist orthopaedic surgeons to understand the clinical characteristics of spinal metastases, and is of great significance in guiding clinical diagnoses and scientific research.

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Section: Discussionsupporting

confidence: 90%

Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study

Feng

Zhang

Yang

et al. 2019

Orthopaedic Surgery

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“…Finally, male sex and the time interval from cancer diagnosis to the start of radiotherapy are the two remaining prognostic factors independently associated with survival in spinal metastasis patients. Among these, primary tumor histology, the presence and number of metastases, and performance status are proposed as the three most important prognostic factors associated with survival in spinal metastasis patients not only in this study but also in most previous investigations [7].…”

Section: Prognostic Factors For Metastatic Spinal Tumorsmentioning

confidence: 74%

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

et al. 2020

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Metastatic spinal tumors are common, and their rising incidence can be attributed to the expanding aging population and increased survival rates among cancer patients. The decision-making process in the treatment of spinal metastasis requires a multidisciplinary approach that includes medical and radiation oncology, surgery, and rehabilitation. Various decision-making systems have been proposed in the literature in order to estimate survival and suggest appropriate treatment options for patients experiencing spinal metastasis. However, recent advances in treatment modalities for spinal metastasis, such as stereotactic radiosurgery and minimally invasive surgical techniques, have reshaped clinical practices concerning patients with spinal metastasis, making a demand for further improvements on current decision-making systems. In this review, recent improvements in treatment modalities and the evolution of decision-making systems for metastatic spinal tumors are discussed.

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“…10,11 Ahmed et al reviewed a series of 176 patients and compared nine scoring systems, finding that the prognostic value of the revised Tokuhashi Score was better than that of Tomita Score and modified Bauer Score. 29 A study by Pollner et al 11 demonstrated that Tomita Score and modified Bauer Score separated the classes of patients with good and moderate prognosis, and patients with poor conditions were easily identified with revised Tokuhashi Score. 11 As most of the above-mentioned systems were constructed on a relatively small number of patients with heterogeneous types of primary tumors, they lack specificity and sensitivity for indicated malignancies.…”

Section: Discussionmentioning

confidence: 99%

<p>Prognostic Significance of a Novel Score Model Based on Preoperative Indicators in Patients with Breast Cancer Spine Metastases (BCSM)</p>

Zhao

Wang

Xiao

et al. 2020

CMAR

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Background Surgery remains the mainstay of treatment for breast cancer spinal metastasis (BCSM) to relieve symptoms and improve the quality of life of BCSM patients. Therefore, it is important to effectively predict the prognosis of patients to determine whether they can undergo surgical operation. However, the prevalent methods for prognosis evaluation lack specificity and sensitivity for indicated malignancies like breast cancer because they are built on a relatively small number of heterogeneous types of primary tumors. The aim of the present study was to explore a novel predictive model based on the clinical, pathological and blood parameters obtained from BCSM patients before they received surgical intervention. Methods Altogether, 144 patients were included in this study. Univariate and multivariate analyses were performed to investigate the significance of preoperative parameters and identify independent factors for prognostic prediction of BCSM. A nomogram for survival prediction was then established and validated. Time-dependent ROC (TDROC) curves were graphed to evaluate the accuracy of the novel model vs other scoring systems including Tomita Score, revised Tokuhashi Score, modified Bauer Score and New England Spinal Metastasis Score. P values <0.05 were considered statistically significant. Results Independent factors, including preoperative postmenopausal ( P =0.034), visceral metastasIs ( P =0.021), preoperative Frankel Score ( P =0.001), estrogen receptor status ( P =0.014), platelet-to-lymphocyte ratio ( P =0.012), lymphocyte-monocyte ratio ( P <0.001) and albumin-globulin ratio ( P =0.017), were selected into the nomogram model with the C-index of 0.834 (95% CI, 0.789–0.890). TDROC curves showed that the Changzheng Hospital (CZ) Score system had the best performance and exhibited the largest IAUC value in comparison with the other scoring systems. Conclusion We constructed a nomogram model known as CZ Score based on the significant factors to predict the prognosis for BCSM patients. The result showed that CZ Score had a better value for prognostic evaluation and surgical decision-making as compared with the other scoring systems.

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Predicting survival for metastatic spine disease: a comparison of nine scoring systems

Cited by 102 publications

References 43 publications

Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study

Epidemiological Characteristics of 1196 Patients with Spinal Metastases: A Retrospective Study

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

<p>Prognostic Significance of a Novel Score Model Based on Preoperative Indicators in Patients with Breast Cancer Spine Metastases (BCSM)</p>

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