Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease

Carrwik, Christian; Olerud, Claes; Robinson, Yohan

doi:10.1097/brs.0000000000003289

Cited by 11 publications

(8 citation statements)

References 21 publications

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“…As previously shown by our group, the use of old prediction models may withhold patients from surgery as they tend to underestimate survival, and this study once again shows the need for reliable prediction tools. 17 The Global Spine Tumour Study Group (GSTSG) has published several articles based on an international cohort of comparable size. While the patients in that cohort show a higher survival rate, 1 year after surgery, the mean age is lower (60 years vs 67 years in our article) and the distribution of cancer types is different.…”

Section: Discussion Key Resultsmentioning

confidence: 99%

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Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study

2021

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ObjectivesTo evaluate survival after surgery and indications for surgery due to spinal metastatic disease.DesignA retrospective longitudinal multiregistry nationwide cohort study.Setting19 public hospitals in Sweden with spine surgery service, where 6 university hospitals account for over 90% of the cases.Participants1820 patients 18 years or older undergoing surgery due to spinal metastatic disease 2006–2018 and registered in Swespine, the Swedish national spine surgery registry.InterventionsDecompressive and/or stabilising spine surgery due to spinal metastatic disease.Primary outcomeSurvival (median and mean) after surgery.Secondary outcomesIndications for surgery, types of surgery and causes of death.ResultsThe median estimated survival after surgery was 6.2 months (95% CI: 5.6 to 6.8) and the mean estimated survival time was 12.2 months (95% CI: 11.4 to 13.1). Neurologic deficit was the most common indication for surgery and posterior stabilisation was performed in 70.5% of the cases. A neoplasm was stated as the main cause of death for 97% of the patients.ConclusionBoth median and mean survival times were well above the generally accepted thresholds for surgical treatment for spinal metastases, suggesting that patient selection for surgical treatment on a national level is adequate. Further research on quality of life after surgery and prognostication is needed.

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Section: Discussion Key Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study

2021

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“…Since that time, there has been increasing use of immunotherapy in non-small cell lung cancer, with 33% of patients with stage IV non-small cell lung cancer receiving immunotherapy in 2018, as compared with 12% in 2016 33. As such, the models may be predisposed to underestimate survival among some subsets of patients 18. Further, the development of artificial intelligence-based models, such as SORG, may allow clinicians to best account for advances in oncologic and surgical treatment 34…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Prognostic Models to Facilitate Surgical Decision-Making for Patients With Spinal Metastatic Disease

Wick

Kalistratova

Piña

et al. 2023

Spine

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Study Design. Retrospective cohort. Objective. Compare the performance of and provide cutoff values for commonly used prognostic models for spinal metastases, including Revised Tokuhashi, Tomita, Modified Bauer, New England Spinal Metastases Score (NESMS), and Skeletal Oncology Research Group model, at three-and six-month postoperative time points. Summary of Background Data. Surgery may be recommended for patients with spinal metastases causing fracture, instability, pain, and/or neurological compromise. However, patients with less than three to six months of projected survival are less likely to benefit from surgery. Prognostic models have been developed to help determine prognosis and surgical candidacy. Yet, there is a lack of data directly comparing the performance of these models at clinically relevant time points or providing clinically applicable cutoff values for the models. Materials and Methods. Sixty-four patients undergoing surgery from 2015 to 2022 for spinal metastatic disease were identified. Revised Tokuhashi, Tomita, Modified Bauer, NESMS, and Skeletal Oncology Research Group were calculated for each patient. Model calibration and discrimination for predicting survival at three months, six months, and final follow-up were evaluated using the Brier score and Uno's C, respectively. Hazard ratios for survival were calculated for the models. The Contral and O'Quigley method was utilized to identify cutoff values for the models discriminating between survival and nonsurvival at three months, six months, and final follow-up. Results. Each of the models demonstrated similar performance in predicting survival at three months, six months, and final follow-up. Cutoff scores that best differentiated patients likely to survive beyond three months included the Revised Tokuhashi score = 10, Tomita score = four, Modified Bauer score = three, and NESMS = one. Conclusion. We found comparable efficacy among the models in predicting survival at clinically relevant time points. Cutoff values provided herein may assist surgeons and patients when deciding whether to pursue surgery for spinal metastatic disease.

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“…Scores for positive prognostic factors with or without visceral metastases, absence of lung cancer, primary tumor in the selected group (breast, kidney, lymphoma, multiple myeloma), and only one isolated skeletal metastasis. The total score was 0-4, where a score of 0-1 indicates a poor prognosis and no recommendation for surgery and a score of 3-4 indicates a more extensive surgery 20 .…”

Section: Methodsmentioning

confidence: 99%

The emergence of new prognostic scores in lung cancer patients with spinal metastasis: A 12-year single-center retrospective study

Chen¹,

Chen²,

Zhou³

et al. 2021

J. Cancer

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Objective: Lung cancer patients exhibit spinal metastases from a specific population, and with this study, we aimed to develop a model that can predict this particular group's survival. Methods: Data were retrospectively collected from 83 lung cancer patients who underwent spinal metastasis surgery at our center from 2009 to 2021. After the initial assessment of treatment and scoring effects, a nomogram for survival prediction was created by identifying and integrating critical prognostic factors, followed by a consistency index (C-index) to measure consistency, and finally, a subject working characteristic curve (ROC) to compare the predictive accuracy of the three existing models. Results: The mean postoperative survival was 14.7 months. Surgical treatment significantly improved the VAS and Frankel scores in lung cancer patients with spinal metastases. The revised Tokuhashi score underestimated the life expectancy of these patients. Six independent prognostic factors, including age, extraspinal bone metastasis foci, visceral metastasis, Frankel score, targeted therapy, and radiotherapy, were identified and incorporated into the model. Calibration curves for 3-, 6-, and 12-month overall survival showed a good concordance between predicted and actual risk. The nomogram C-index for the cohort study was 0.800 (95% confidence interval [CI]: 0.757-0.843). Model comparisons showed that the nomogram's prediction accuracy was better than revised Tokuhashi and Bauer's scoring systems. Conclusions: Spine surgery offered patients the possibility of regaining neurological function. Having identified shortcomings in existing scoring systems, we have recreated and validated a new nomogram that can be used to predict survival outcomes in patients with spinal metastases from lung cancer, thereby assisting spinal surgeons in making surgical decisions and personalizing treatment for these patients.

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Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease

Cited by 11 publications

References 21 publications

Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study

Survival after surgery for spinal metastatic disease: a nationwide multiregistry cohort study

A Comparison of Prognostic Models to Facilitate Surgical Decision-Making for Patients With Spinal Metastatic Disease

The emergence of new prognostic scores in lung cancer patients with spinal metastasis: A 12-year single-center retrospective study

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