Multicentre external validation of the new England spinal metastasis score (NESMS) in operative and nonoperative patients with metastatic spinal cord compression.
William Giles, Lori Low, Anna L Watts, Vasudha Narayanaswamy, Osanmofe Gbenebichie, Alex Burnett, Doreen Koske, Caroline Wilson, Neil Chiverton, James Tomlinson, Shreya Srinivas
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引用次数: 0
Abstract
Background context: Metastatic spinal cord compression (MSCC) presents complex treatment dilemmas where predicting survival is crucial for clinical decision-making.
Purpose: The New England Spinal Metastasis Score (NESMS) has shown promise, but external validation is needed to confirm its broader applicability.
Study design: Patients were assigned NESMS retrospectively based on ambulatory status, serum albumin level, and modified Bauer score.
Patient sample: This retrospective multicentre study included 322 adult patients with radiologically confirmed MSCC who presented for initial treatment over a 3-year period at 2 partner institutions.
Outcome measures: The primary outcome was mortality at 12 months, with secondary outcomes of mortality at 3 and 6 months.
Methods: Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate NESMS performance in predicting mortality and its discriminative capacity, while adjusting for potential confounders.
Results: The cohort had a median age of 70 years, with 65% male patients. Overall 12-month mortality was 75%. NESMS demonstrated excellent discriminative capacity for predicting 12-month mortality (c-statistic 0.82, p<.001) with clear stepwise differences in survival between NESMS levels (mortality: NESMS 0=98%, NESMS 1=88%, NESMS 2=75%, NESMS 3=46%). Multivariate analysis confirmed significantly greater odds of mortality with decreasing NESMS (NESMS 0: OR 35.92, CI 6.90-662.6; NESMS 1: OR 6.97, CI 3.22-16.02; NESMS 2: OR 2.69, CI 1.35-5.42; all p<.05 compared to NESMS 3). Operative management was associated with significantly lower mortality (OR 0.28, CI 0.15-0.51; p<.001).
Conclusions: This study externally validates the usefulness of the NESMS in predicting survival for both operative and nonoperative patients with MSCC. Further, we observed clear stepwise increases in mortality with worsening NESMS.
期刊介绍：
The Spine Journal, the official journal of the North American Spine Society, is an international and multidisciplinary journal that publishes original, peer-reviewed articles on research and treatment related to the spine and spine care, including basic science and clinical investigations. It is a condition of publication that manuscripts submitted to The Spine Journal have not been published, and will not be simultaneously submitted or published elsewhere. The Spine Journal also publishes major reviews of specific topics by acknowledged authorities, technical notes, teaching editorials, and other special features, Letters to the Editor-in-Chief are encouraged.
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