Accuracy and precision of the spinal instability neoplastic score (SINS) for predicting vertebral compression fractures after radiotherapy in spinal metastases: a meta-analysis

Abstract

Radiotherapy has played an important role in the treatment of spinal metastases. One of the major complications of radiotherapy is vertebral compression fracture (VCF). Although the spinal instability neoplastic score (SINS) was developed for evaluating spinal instability in patients with spinal metastases, it is also commonly used to predict VCF after radiotherapy in patients with spinal metastases. However, its accuracy for predicting radiotherapy-induced VCF and precision remain controversial. The aim of this study was to clarify the diagnostic value of the SINS to predict radiotherapy-induced VCF and to make recommendations for improving its diagnostic power. We searched core databases and identified 246 studies. Fourteen studies were analyzed, including 7 studies (with 1269 segments) for accuracy and 7 studies (with 280 patients) for precision. For accuracy, the area under the summary receiver operating characteristic curve was 0.776. When a SINS cut-off value of 7 was used, as was done in the included studies, the pooled sensitivity was 0.790 and the pooled specificity was 0.546. For precision, the summary estimate of interobserver agreement was the highest dividing 2 categories based on a cut-off value of 7, and the value was 0.788. The body collapse showed moderate relationship and precision with the VCF. The lytic tumor of bone lesion showed high accuracy and fair reliability, while location had excellent reliability, but low accuracy. The SINS system can be used to predict the occurrence of VCF after radiotherapy in spinal metastases with moderate accuracy and substantial reliability. Increasing the cut-off value and revising the domains may improve the diagnostic performance to predict the VCF of the SINS.

Evaluation of Load-To-Strength Ratios in Metastatic Vertebrae and Comparison With Age- and Sex-Matched Healthy Individuals

“…However, the SINS overall score was not predictive of PVF risk, which was also reported by Germano et al (2016). A recent meta-analysis (Kim et al, 2021) suggested that higher SINS scores moderately predict PVF in patients after radiotherapy with a pooled sensitivity of 0.790 (95% CI 0.723-0.843) and a pooled specificity of 0.546 (0.462-0.62). Given the significant challenges of quantifying the risk of PVF clinically (Fourney et al, 2011;Boehling et al, 2012), better fracture risk prediction represents an important and unmet medical need (Galasko, 1986;Aebi, 2003;Bartanusz and Porchet, 2003;Groot et al, 2006).…”

Vertebral body collapse after radiotherapy for spinal metastases

“…Although conventional RT is most commonly utilized for spinal SREs, the occurrence of new VBC during RT has not been fully investigated previously (10,11,(15)(16)(17)(18)(19)(20)(21)(22)(23). Shi (10).…”

Spinal Metastases: Impact of early surgery plus concomitant radiation compared to radiation therapy only on health-related quality of life and overall survival

“…These ndings align with existing literature (that underscores the signi cance of early detection and surgical intervention in enhancing the outcomes of patients with spinal metastases. [3][4][5][6]12,14,16,19,[24][25][26][27] Furthermore, our study highlights the relevance of the Spinal Instability Neoplastic Score (SINS) as a valuable tool for informing treatment decisions. By employing SINS to assess the degree of instability and the necessity for surgery, healthcare providers can customize treatment plans to individual patients, potentially augmenting their HRQoL and survival.…”

“…Key features of metastasis of the vertebral column include pain, neurological de cits that can cumulate in a para-or tetraplegia, and biomechanical instability. The latter was addressed by development of the Spinal Instability Neoplastic Score (SINS) [2][3][4][5][6][7][8][9][10][11][12][13][14] . This scoring system takes several factors such as the location, pain, and type of spinal lesion into account to determine the degree of instability and the need for surgical intervention.…”