Validation of Traditional Prognosis Scoring Systems and Skeletal Oncology Research Group Nomogram for Predicting Survival of Spinal Metastasis Patients Undergoing Surgery

Abstract

Background Many scoring systems that predict overall patient survival are based on clinical parameters and primary tumor type. To date, no consensus exists regarding which scoring system has the greatest predictive survival accuracy, especially when applied to specific primary tumors. Additionally, such scores usually fail to include modern treatment modalities, which influence patient survival. This study aimed to evaluate both the overall predictive accuracy of such scoring systems and the predictive accuracy based on the primary tumor. Methods A retrospective review on spinal metastasis patients who were aged more than 18 years and underwent surgical treatment was conducted between October 2008 and August 2018. Patients were scored based on data before the time of surgery. A survival probability was calculated for each patient using the given scoring systems. The predictive ability of each scoring system was assessed using receiver operating characteristic analysis at postoperative time points; area under the curve was then calculated to quantify predictive accuracy. Results A total of 186 patients were included in this analysis: 101 (54.3%) were men and the mean age was 57.1 years. Primary tumors were lung in 37 (20%), breast in 26 (14%), prostate in 20 (10.8%), hematologic malignancy in 18 (9.7%), thyroid in 10 (5.4%), gastrointestinal tumor in 25 (13.4%), and others in 40 (21.5%). The primary tumor was unidentified in 10 patients (5.3%). The overall survival was 201 days. For survival prediction, the Skeletal Oncology Research Group (SORG) nomogram showed the highest performance when compared to other prognosis scores in all tumor metastasis but a lower performance to predict survival with lung cancer. The revised Katagiri score demonstrated acceptable performance to predict death for breast cancer metastasis. The Tomita and revised Tokuhashi scores revealed acceptable performance in lung cancer metastasis. The New England Spinal Metastasis Score showed acceptable performance for predicting death in prostate cancer metastasis. SORG nomogram demonstrated acceptable performance for predicting death in hematologic malignancy metastasis at all time points. Conclusions The results of this study demonstrated inconsistent predictive performance among the prediction models for the specific primary tumor types. The SORG nomogram revealed the highest predictive performance when compared to previous survival prediction models.

Comparing the Accuracy of Seven Scoring Systems in Predicting Survival of Lung Cancer Patients With Spinal Metastases

“…Smeijers et al 14 concluded that the SORG nomogram enjoyed a superior performance in survival prediction for surgery in spinal metastases. Although the external validation of the SORG nomogram indicated a superior predictive ability, [33][34][35] the nomogram performed poorly in estimating survival with an accuracy of 0.618 for 90 days, and 0.621 for 365 days in the present study.…”

Hematologic Malignancies Influence the Accuracy of Prediction of Survival in Patients With Solid Tumor Spinal Metastases Undergoing Surgery

“…[7][8][9][10] accurate at predicting the survival of patients with spinal metastasis undergoing surgery. 11 In the same study, we found significant differences in the median survival times between spinal metastases from hematologic malignancies (lymphomas and multiple myeloma) and other solid tumor metastases. Therefore, we hypothesized that spinal metastases caused by hematologic malignancies have different prognostic predictors than those from other solid tumors.…”

“…Many scoring systems for predicting the duration of survival have been proposed; however, the accuracy of such scoring systems varies significantly. 11,12 Because most traditional scoring systems were developed on the basis of data analysis from before the modern era of adjuvant treatment and new surgical techniques, they are often inaccurate, especially in terminally ill patients, [13][14][15] as shown in previous studies. [16][17][18] Our previous study showed that the accuracy of the available predictive models differs and demonstrated that the Skeletal Oncology Research Group (SORG) system is the most…”

When Should Spinal Surgery Be Considered for Spinal Metastasis from Non-Small Cell Lung Cancer?—Propensity Score Matched Study between Surgery with Radiotherapy and Radiotherapy Alone

“…Moreover, recent studies have shown that surgery with radiotherapy for MSD results in better outcomes, including quality of life, than radiotherapy alone [6,7]. Surgery's role in MSD is appropriately discussed in specific situations because tumor origin sites and patients' conditions differ [16]. Therefore, this study was designed to evaluate the role of surgery compared to radiotherapy alone, confined to patients with thoracic spine metastasis of NSCLC and similar conditions by propensity score matching.…”

“…The purpose of the surgery was to provide decompression of the spinal cord and stabilization using bone grafting and fixation devices in a palliative setting [2]. The surgical procedures were tailored for each patient depending on the location of the tumors and the patient's condition [16]. In general, anterior corpectomy or posterior vertebral column resection (PVCR) with interbody bone grafting was performed for anteriorly located tumors with vertebral body collapse and spinal instability [17].…”