Prognostic models for spinal metastatic disease: evolution of methodologies, limitations, and future opportunities

Karhade, Aditya V.; Shin, John H.; Schwab, Joseph H.

doi:10.21037/atm.2019.04.87

Cited by 13 publications

(12 citation statements)

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“…However, the performance status and the progression of the disease to skeletal, visceral, or brain metastasis were frequently assessed. 23 More factors related to nutritional status and chronic inflammation (albumin, C-reactive protein, lactate dehydrogenase, white blood cell count, hemoglobin) were included in more recent models. 14,15,17 A meta-analysis identified 17 different prognostic factors associated with survival in spinal metastasis and highlighted that the revised Tokuhashi score was the most cited, with an overall predictive value of 66%.…”

Section: Discussionmentioning

confidence: 99%

Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

Massaad¹,

Hadzipasic²,

Alvarez‐Breckenridge³

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVEAlthough several prognostic scores for spinal metastatic disease have been developed in the past 2 decades, the applicability and validity of these models to specific cancer types are not yet clear. Most of the data used for model formation are from small population sets and have not been updated or externally validated to assess their performance. Developing predictive models is clinically relevant as prognostic assessment is crucial to optimal decision-making, particularly the decision for or against spine surgery. In this study, the authors investigated the performance of various spinal metastatic disease risk models in predicting prognosis for spine surgery to treat metastatic renal cell carcinoma (RCC).METHODSData of patients who underwent surgery for RCC metastatic to the spine at 2 tertiary centers between 2010 and 2019 were retrospectively retrieved. The authors determined the prognostic value associated with the following scoring systems: the Tomita score, original and revised Tokuhashi scores, original and modified Bauer scores, Katagiri score, the Skeletal Oncology Research Group (SORG) classic algorithm and nomogram, and the New England Spinal Metastasis Score (NESMS). Regression analysis of patient variables in association with 1-year survival after surgery was assessed using Cox proportional hazard models. Calibration and time-dependent discrimination analysis were tested to quantify the accuracy of each scoring system at 3 months, 6 months, and 1 year.RESULTSA total of 86 metastatic RCC patients were included (median age 64 years [range 29–84 years]; 63 males [73.26%]). The 1-year survival rate was 72%. The 1-year survival group had a good performance status (Karnofsky Performance Scale [KPS] score 80%–100%) and an albumin level > 3.5 g/dL (p < 0.05). Multivariable-adjusted Cox regression analysis showed that poor performance status (KPS score < 70%), neurological deficit (Frankel grade A–D), and hypoalbuminemia (< 3.5 g/dL) were associated with a higher risk of death before 1 year (p < 0.05). The SORG nomogram, SORG classic, original Tokuhashi, and original Bauer demonstrated fair performance (0.7 < area under the curve < 0.8). The NESMS differentiates survival among the prognostic categories with the highest accuracy (area under the curve > 0.8).CONCLUSIONSThe present study shows that the most cited and commonly used scoring systems have a fair performance predicting survival for patients undergoing spine surgery for metastatic RCC. The NESMS had the best performance at predicting 1-year survival after surgery.

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Section: Discussionmentioning

confidence: 99%

Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

Massaad¹,

Hadzipasic²,

Alvarez‐Breckenridge³

et al. 2020

Journal of Neurosurgery: Spine

Self Cite

View full text Add to dashboard Cite

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“…250 IU/L, or serum albumin <3.7 g/dL or platelet count <100,000/lL, serum calcium level !10.3 mg/dL, or total bilirubin !1.4) were associated with decreased survival. Kardhade et al also included multiple laboratory data in their machine learning model [38]. Nonetheless, the evidence of these models is still limited as there has not been an external validation yet.…”

Section: Discussionmentioning

confidence: 99%

Impact of body fat distribution and sarcopenia on the overall survival in patients with spinal metastases receiving radiotherapy treatment: a prospective cohort study

et al. 2019

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Introduction: An increasing number of patients is diagnosed with spinal metastases due to elevated cancer incidence and improved overall survival. Patients with symptomatic spinal bone metastases often receive radiotherapy with or without surgical stabilisation. Patients with a life expectancy of less than 3 months are generally deemed unfit for surgery, therefore adequate pre-treatment assessment of life expectancy is necessary. The aim of this study was to assess new factors associated with overall survival for this category of patients. Patients and methods: Patients who received radiotherapy for thoracic or lumbar spinal metastases from June 2013 to December 2016 were included in this study. The pre-treatment planning CT for radiotherapy treatment was used to assess the patient's visceral fat area, subcutaneous fat area, total muscle area and skeletal muscle density on a single transverse slice at the L3 level. The total muscle area was used to assess sarcopenia. Furthermore, data were collected on age, sex, primary tumour, Karnofsky performance score, medical history, number of bone metastases, non-bone metastases and neurological symptoms. Univariable and multivariable cox regressions were performed to determine the association between our variables of interest and the survival at 90 and 365 days. Results: A total of 310 patients was included. The median age was 67 years. Overall survival rates for 90 and 365 days were 71% and 36% respectively. For 90-and 365-day survival, the Karnofsky performance score, muscle density and primary tumour were independently significantly associated. The visceral or subcutaneous fat area and their ratio and sarcopenia were not independently associated with overall survival. Conclusions: Of the body morphology, only muscle density was statistically significant associated with overall survival after 90 and 365 days in patients with spinal bone metastases. Body fat distribution was not significantly associated with overall survival.

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“…Classically, prognostic models for spinal metastasis have been developed using logistic or proportional hazards regression analyses. As part of its research efforts, the SORG was able to develop prognostic models using machine-learning algorithms such as gradient boosting, decision trees, random forests, and neural networks [ 20 , 41 ], and these algorithms were externally validated elsewhere [ 29 ]. Like in other fields of medicine, evolving computational methodologies, including machine-learning algorithms, should be assessed extensively in terms of their potential in the management of spinal metastasis.…”

Section: Decision-making Systems For Managing Metastatic Spinal Tumormentioning

confidence: 99%

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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Prognostic models for spinal metastatic disease: evolution of methodologies, limitations, and future opportunities

Cited by 13 publications

References 54 publications

Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

Impact of body fat distribution and sarcopenia on the overall survival in patients with spinal metastases receiving radiotherapy treatment: a prospective cohort study

Treatment Strategy for Metastatic Spinal Tumors: A Narrative Review

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