The Performance of Prognostic Measures for Survival in Spinal Metastatic Disease in Light of Modern Advancements in Medical and Surgical Management.

IF 3.7 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2026-10-15 Epub Date: 2026-05-18 DOI:10.1097/BRS.0000000000005741

Brendan M Striano, Marco L Ferrone, Kaitlyn E Holly, Christy Zheng, Andrew Nguyen, Joseph Macksood, Amelia Osgood, Joshua M Coan, J Prescott Chan, Patrick K Cronin, Daniel G Tobert, Andrew J Schoenfeld

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引用次数: 0

Abstract

Study design: Retrospective cohort.

Objective: To compare the performance of four of the most widely used scoring systems for survival in spinal metastatic disease among a representative battery of cases treated in our health system during 2017 to 2022.

Summary of background data: None of the popular risk scores in use today effectively account for improved survival due to advancements in immunotherapy, molecular targeted treatment, and surgical techniques.

Methods: We assembled a representative battery of 997 patients who underwent operative or nonoperative treatment for spinal metastases (2017-2022). All patients were assigned a Tokuhashi score, Tomita score, Skeletal Oncology Research Group (SORG), and New England Spinal Metastasis Score (NESMS) based on data at initial presentation. The primary outcome was the discriminative capacity of the scoring utilities in predicting one-year mortality. This was evaluated using multivariable logistic regression with all variables included as co-variates. The discriminative capacity for each model was compared using the c-statistic. We also assessed the performance of operative management in conjunction with the survival score.

Results: One-year mortality was 54%. The SORG's c-statistic was 0.75 (95% CI: 0.71, 0.78), compared with 0.68 (95% CI: 0.65, 0.71) for the NESMS. The c-statistic for the Tokuhashi score was 0.70 (95% CI: 0.67, 0.73), while that of the Tomita scale was 0.66 (95% CI: 0.63, 0.69). Only the SORG (OR: 0.64; 95% CI: 0.46, 0.90; P =0.01) and NESMS (OR: 0.74; 95% CI: 0.56, 0.97; P =0.03) preserved a significant association between surgical intervention and survival.

Conclusions: We found that the performance of all scores was diminished relative to historical reports, but remained adequate for the NESMS and SORG algorithms. In current practice, we believe the optimal approach entails initial use of the NESMS when considering treatment approaches, with the SORG used for recalculating survival if surgical intervention has been selected as a treatment strategy.

Level of evidence: Level III.

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根据现代医学和外科治疗的进展，对脊柱转移性疾病生存的预后措施的表现。

研究设计：回顾性队列。目的：比较2017-2022年期间在我国卫生系统治疗的具有代表性的病例中，四种最广泛使用的脊髓转移性疾病生存评分系统的性能。背景资料总结：目前使用的流行风险评分都不能有效地解释由于免疫治疗、分子靶向治疗和手术技术的进步而提高的生存率。方法：我们收集了具有代表性的997例接受手术或非手术治疗的脊柱转移患者（2017-22）。所有患者根据首次就诊时的数据分配Tokuhashi， Tomita，骨骼肿瘤研究组（SORG）和新英格兰脊柱转移评分（NESMS）。主要结果是评分工具在预测1年死亡率方面的判别能力。使用多变量逻辑回归对所有变量作为协变量进行评估。使用c统计量比较每个模型的判别能力。我们还结合生存评分评估了手术管理的表现。结果：1年死亡率为54%。SORG的c统计量为0.75 (95% CI 0.71, 0.78)，而NESMS的c统计量为0.68 （95% CI 0.65, 0.71）。Tokuhashi评分的c统计量为0.70 (95% CI 0.67, 0.73)，而Tomita量表的c统计量为0.66 （95% CI 0.63, 0.69）。只有SORG （OR 0.64; 95% CI 0.46, 0.90； P=0.01）和NESMS （OR 0.74; 95% CI 0.56, 0.97； P=0.03）保留了手术干预与生存之间的显著关联。结论：我们发现，与历史报告相比，所有分数的表现都有所下降，但对于NESMS和SORG算法仍然足够。在目前的实践中，我们认为最优的方法是在考虑治疗方法时首先使用NESMS，如果选择手术干预作为治疗策略，则使用SORG重新计算生存率。证据水平：III。

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

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.