Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression

Tabouret, Émeline; Cauvin, C.; Fuentès, S.; Esterni, Benjamin; Adetchessi, T.; Salem, Naji; Madroszyk, Anne; Gonçalvès, Anthony; Casalonga, F.; Gravis, Gwénaëlle

doi:10.1016/j.spinee.2013.06.036

Cited by 75 publications

(51 citation statements)

References 28 publications

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“…Repartition into scoring systems (Table 2) At the time of MSCC diagnosis, 8, 15, and 6 long-term survival patients were distributed into the best (12-15), intermediate (9)(10)(11), and poor (0-8) Tokuhashi's classes, respectively. More than 70 % of these long-term survivor patients were, therefore, not classified into the best Using univariate analyses, the prognostic factors for long-term survivor patients associated with the best OS were: the type of surgery (laminectomy with or without fixation or vertebrectomy vs kyphoplasty, p = 0.022), no use of radiotherapy post-surgery (p = 0.049), and hematological primary malignancies (p = 0.006).…”

Section: Resultsmentioning

confidence: 99%

“…Even though these authors proposed to determine therapeutic approach using their classification systems, they appeared to be unable to appropriately select patients who had a good prognosis. Moreover, lack of accuracy of these scores has already been reported by authors [11,17]. Rades et al [12] proposed a new scoring system for use in identifying patients who would survive over 1 year, with very high specificity and positive predictive values.…”

Section: Discussionmentioning

confidence: 99%

“…Several predictive scores have been published to assist in making treatment decisions, and the most currently used are those established by Tokuhashi [8] and Tomita [9]; both recommended that treatment strategies should be based on survival prediction according to these tools' classifications. However, these scores were redundant and their validities were not confirmed [10,11], underlining the remaining crucial role of the use of multidisciplinary consultation. Simultaneously, long-term survival of MSCC patients has been suggested to increase, but to date no clear data have been reported on this issue [5].…”

Section: Introductionmentioning

confidence: 96%

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Long-term survivors after surgical management of metastatic spinal cord compression

et al. 2014

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Long-term survivors after surgical management of metastatic spinal cord compression

et al. 2014

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“…11,26,45,52,53 However, these scoring systems have a limited prognostic capability. 14,41,49 With continued refinements to surgical technique as well as advances in implant technology, surgeons are able to undertake increasingly ambitious resections followed by complex reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

Zakaria¹,

Basheer²,

Boyce-Fappiano

et al. 2016

FOC

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OBJECTIVE Predicting the survival rate for patients with cancer is currently performed using the TNM Classification of Malignant Tumors (TNM). Identifying accurate prognostic markers of survival would allow better treatment stratification between more aggressive treatment strategies or palliation. This is especially relevant for patients with spinal metastases, who all have identical TNM staging and whose surgical decision-making is potentially complex. Analytical morphometrics quantifies patient frailty by measuring lean muscle mass and can predict risk for postoperative morbidity after lumbar spine surgery. This study evaluates whether morphometrics can be predictive of survival in patients with spinal metastases. METHODS Utilizing a retrospective registry of patients with spinal metastases who had undergone stereotactic body radiation therapy, the authors identified patients with primary lung cancer. Morphometric measurements were taken of the psoas muscle using CT of the lumbar spine. Additional morphometrics were taken of the L-4 vertebral body. Patients were stratified into tertiles based on psoas muscle area. The primary outcome measure was overall survival, which was measured from the date of the patient's CT scan to date of death. RESULTS A total of 168 patients were identified, with 54% male and 54% having multiple-level metastases. The median survival for all patients was 185.5 days (95% confidence interval [CI] 146–228 days). Survival was not associated with age, sex, or the number of levels of metastasis. Patients in the smallest tertile for the left psoas area had significantly shorter survival compared with a combination of the other two tertiles: 139 days versus 222 days, respectively, hazard ratio (HR) 1.47, 95% CI 1.06–2.04, p = 0.007. Total psoas tertiles were not predictive of mortality, but patients whose total psoas size was below the median size had significantly shorter survival compared with those greater than the median size: 146 days versus 253.5 days, respectively, HR 1.43, 95% CI 1.05–1.94, p = 0.025. To try to differentiate small body habitus from frailty, the ratio of psoas muscle area to vertebral body area was calculated. Total psoas size became predictive of mortality when normalized to vertebral body ratio, with patients in the lowest tertile having significantly shorter survival (p = 0.017). Left psoas to vertebral body ratio was also predictive of mortality in patients within the lowest tertile (p = 0.021). Right psoas size was not predictive of mortality in any calculations. CONCLUSIONS In patients with lung cancer metastases to the spine, morphometric analysis of psoas muscle and vertebral body size can be used to identify patients who are at risk for shorter survival. This information should be used to select patients who are appropriate candidates for surgery and for the tailoring of oncological treatment regimens.

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“…While the categorization by this system lacked precision, with the intermediate group partially overlapping the good prognosis group, it was applied inappropriately by rigidly defining scores of 9-11 as corresponding to a survival period of 6 months to 1 year [21][22][23][24] , and the agreement rate between the prognostic category and survival period was low in all these reports.…”

Section: Scoring System For Predicting Life Expectancy 1) Classicmentioning

confidence: 99%

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

Tokuhashi

Uei

Oshima

2017

Spine Surg Relat Res

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Abstract:Introduction: Accurate evaluation of metastasis and life prognosis is essential for selecting a suitable therapeutic strategy for metastatic spine tumors owing to limitations in treatment options. For this purpose, various classification, evaluation, and scoring systems have been developed.Methods: Classification, evaluation, and scoring systems for metastatic spine tumors reported to date were identified by performing a literature search on PubMed. We reviewed the most cited classifications and scorings before 2009, and all classifications and scorings reported after 2010 from the search results.Results: Six classifications and 23 scorings were reviewed. The classification/evaluation methods are divided into 1) anatomical classification/evaluation methods, 2) evaluation methods for neurological symptoms/instability, and 3) scoring systems for predicting life expectancy. The first 2 were useful for the planning and evaluation of surgical indications. Scoring systems for life prognosis also permitted rough prediction of the outcomes and were useful for the selection of a suitable treatment. However, variation of the patient background, diversity of adopted prognostic factors, and the absence of scoring systems that could predict the outcome with an accuracy of 90% or higher introduced some limitations.Conclusion: The identified classification, evaluation, and scoring systems have been generally useful for treatment strategies. However, we emphasize the necessity of multidisciplinary development and revision of classification and evaluation methods to adapt to the prolongation of survival associated with increased diversity and improvement of treatment options.

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Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression

Cited by 75 publications

References 28 publications

Long-term survivors after surgical management of metastatic spinal cord compression

Long-term survivors after surgical management of metastatic spinal cord compression

Application of morphometric analysis to patients with lung cancer metastasis to the spine: a clinical study

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

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