Validation of the prognostic index for spine metastasis (PRISM) for stratifying survival in patients treated with spinal stereotactic body radiation

IF 4.9 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2024-10-02 DOI:10.1016/j.radonc.2024.110570

Marcus A. Florez , Brian De , Roman Kowalchuk , Chad Tang , Andrew J. Bishop , Ramez Kouzy , Behrang Amini , Tina Briere , Thomas H. Beckham , Chenyang Wang , Jing Li , Claudio E. Tatsui , Laurence D. Rhines , Paul D. Brown , Kenneth Merrell , Amol J. Ghia

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引用次数: 0

Abstract

Purpose

The Prognostic Index for Spinal Metastasis (PRISM) is a scoring system derived from prospective data from a single institution that stratifies patients undergoing spine stereotactic radiosurgery (SSRS) for spinal metastases into subgroups by overall (OS). We sought to further demonstrate its generalizability by performing validation with a large dataset from a second high-volume institution, Mayo Clinic.

Methods and materials

Eight hundred seventy-nine patients—424 from Mayo Clinic and 455 from MD Anderson Cancer Center (MDACC)—who received SSRS between 2007 and 2019 were identified. Patients were stratified by PRISM criteria, and overall survival (OS) for the PRISM groups for each cohort was compared using Kaplan-Meier estimations and univariate Cox proportional analyses. Model calibration and concordance indices (C-indices) were calculated for each cohort to assess the quality of the scoring system.

Results

Patient and tumor characteristics varied significantly between both cohorts including histology, sex, performance status, and number of organs involved (all P < 0.001). Median OS was 30.3 and 22.1 months for the Mayo and MDACC cohorts, respectively. Kaplan-Meier survival curves revealed robust separation between prognostic groups within both cohorts. The Mayo cohort showed median OS of 57.1, 37.0, 23.7, and 8.8 months for Groups 1, 2, 3, and 4, respectively. Univariate analysis revealed hazard ratios of 3.0 (95 % confidence interval [CI], 1.9–4.9), 5.2 (95 % CI, 3.2–8.3), and 12.9 (95 % CI, 7.8–21.4) for groups 2, 3 and 4, respectively all P < 0.001). The C-indices were 0.69 and 0.66 for the unstratified and stratified scores for the Mayo cohort, and 0.70 and 0.68 for the MDACC cohort, respectively.

Conclusion

These data demonstrate robust validation of the PRISM score to stratify OS in patients treated with SSRS by a large external cohort, despite substantial differences among the cohorts. Overall, the PRISM scoring may help guide optimal treatment selection for patients with spine metastases.

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验证脊柱转移预后指数（PRISM）对脊柱立体定向体放射治疗患者生存率的分层作用。

目的：脊柱转移预后指数（PRISM）是一个评分系统，它来自于一家机构的前瞻性数据，可将接受脊柱立体定向放射外科手术（SSRS）治疗脊柱转移的患者按总体（OS）分为不同的亚组。我们试图利用第二家高容量机构梅奥诊所的大型数据集进行验证，以进一步证明该方法的普适性：我们确定了2007年至2019年期间接受SSRS治疗的879名患者（梅奥诊所424名，MD安德森癌症中心（MDACC）455名）。根据PRISM标准对患者进行分层，并使用Kaplan-Meier估计和单变量Cox比例分析比较每个队列中PRISM组的总生存期（OS）。计算了每个队列的模型校准和一致性指数（C-indices），以评估评分系统的质量：结果：两个队列的患者和肿瘤特征存在显著差异，包括组织学、性别、表现状态和受累器官数量（均为 P）：这些数据表明，尽管各队列之间存在很大差异，但PRISM评分在对接受SSRS治疗的患者进行OS分层方面得到了大量外部队列的有力验证。总体而言，PRISM 评分有助于指导脊柱转移患者的最佳治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.