Accuracy of Preoperative Scoring Systems for the Prognostication and Treatment of Patients with Spinal Metastases

Abstract

Background In patients with spinal metastatic disease, survival prognosis is a key consideration in selection for surgery and determining the extent of treatment. Individual survival prediction however remains difficult. We sought to validate the prognostic accuracy of seven preoperative scoring systems. Methods 61 patients surgically treated for spinal metastases were retrospectively reviewed. Preoperative scores were calculated for Tokuhashi, Revised Tokuhashi, Bauer, Modified Bauer, Sioutos, Tomita, and van der Linden scoring systems. Prognostic value was determined by comparison of predicted and actual survival. Results The Revised Tokuhashi and Modified Bauer scoring systems had the best survival predictive accuracy. Rate of agreement for survival prognosis was the greatest for the Modified Bauer score. There was a significant difference in survival of the prognostic groups for all but the van der Linden score, being most significant for the Revised Tokuhashi, Bauer, Modified Bauer, and Tomita scoring systems (p ≤ 0.001). ConclusionOverall, the scoring systems are accurate at differentiating patients into short-, intermediate-, and long-term survivors. More precise prediction of actual survival is limited and the decision for or against surgery should never be based on survival prognostication alone but should take into account symptoms such as neurological deficit or pain from pathological fracture and instability.

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“…39 Multidisciplinary team tumor management has been shown to be associated with improved clinical outcome. 40,41 From our point of view, and in agreement with Leithner et al 42 and Hibberd and Quan, 43 surgery for patients with SPM should not be based on survival forecast alone. It is compulsory to take into account the KPS score, the neurological status (pain and deficit), and spinal instability.…”

Trends in Survival and Surgical Methods in Patients Surgically Treated for Metastatic Spinal Tumors: 25-Year Experience in a Single Institution

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“…More relevant to our paper, an important line of work shows vast gaps in healthcare coverage, treatment, and outcomes across racial groups ( Williams et al, 2019 ). Prior research, for example, has observed large differences in access to healthcare and in the health outcomes that result downstream ( Higginson and Costantini, 2002 ; Kawachi et al, 2002 ; Graham, 2009 ; Cheon et al, 2016 ; Hibberd and Quan, 2017 ). Recent experimental work also indicates that doctors might have strong biases that can arise even in the context of critical lifesaving situations ( Crabtree et al, 2022a ).…”