Are spine metastasis survival scoring systems outdated and do they underestimate life expectancy? Caution in surgical recommendation guidance

View More View Less
  • 1 Department of Neurosurgery, Bretonneau Hospital, Tours;
  • | 2 Department of Neurosurgey/Neurotraumatology, Hôtel-Dieu Hospital, Nantes;
  • | 3 Department of Orthopedic Surgery, Mondor Hospital–APHP, Créteil;
  • | 4 Department of Orthopedic Surgery, Trousseau Hospital, Tours; and
  • | 5 Departments of Orthopedic Surgery and
  • | 6 Neurosurgery, La Pitié-Salpêtrière Hospital–APHP, Paris, France
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Survival scoring systems for spine metastasis (SPM) were designed to help surgical practice. The authors sought to validate the prognostic accuracy of the main preoperative scoring systems for SPM.

METHODS

It was hypothesized that true patient survival in SPM was better than that predicted using prognosis scores. To investigate this hypothesis, the authors designed a French national retrospective study of a prospectively collected multicenter database involving 739 patients treated for SPM between 2014 and 2017.

RESULTS

In this series, the median survival time for all patients from an SPM diagnosis was 17.03 ± 1.5 months. Sensitivity and specificity were estimated using the area under the curve (AUC). The AUC of Tomita’s prognosis score was the lowest and poorest (0.4 ± 0.023, range 0.35–0.44), whereas the AUC of the Tokuhashi score was the highest (0.825). The Lei score presented an AUC of 0.686 ± 0.022 (range 0.64–0.7), and the Rades score showed a weaker AUC (0.583 ± 0.020, range 0.54–0.63). Differences among AUCs were all statistically significant (p < 0.001). The modified Bauer score and the Rades score had the highest rate of agreement in predicting survival, with a weighted Cohen’s kappa of 0.54 and 0.41, respectively, indicating a moderate agreement. The revised Tokuhashi and Lei scores had a fair rate of agreement (weighted Cohen’s kappa = 0.24 and 0.22, respectively). The van der Linden and Tomita scores demonstrated the worst performance, with only a “slight” rate of agreement (weighted Cohen’s kappa = 0.19 and 0.16, respectively) between what was predicted and the actual survival.

CONCLUSIONS

The use of prognostic scoring systems in the estimation of survival in patients with SPM has become obsolete and therefore underestimates survival. Surgical treatment decisions should no longer be based on survival estimations alone but must also take into account patient symptoms, spinal instability, and quality of life.

ABBREVIATIONS

AUC = area under the curve; GI = gastrointestinal; KPS = Karnofsky Performance Scale; OS = overall survival; ROC = receiver operating characteristic; SPM = spine metastasis.

Illustration from Rothrock et al. (pp 535–545). Copyright Roberto Suazo. Published with permission.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15(4):365373.

    • Search Google Scholar
    • Export Citation
  • 2

    Patil CG, Lad SP, Santarelli J, Boakye M. National inpatient complications and outcomes after surgery for spinal metastasis from 1993–2002. Cancer. 2007;110(3):625630.

    • Search Google Scholar
    • Export Citation
  • 3

    Amelot A, Terrier LM, Mazeron JJ, et al. Timeline metastatic progression: in the wake of the « seed and soil » theory. Med Oncol. 2017;34(11):185.

    • Search Google Scholar
    • Export Citation
  • 4

    Delank KS, Wendtner C, Eich HT, Eysel P. The treatment of spinal metastases. Dtsch Arzteblatt Int. 2011;108(5):7180.

  • 5

    Byrne TN. Spinal cord compression from epidural metastases. N Engl J Med. 1992;327(9):614619.

  • 6

    Tabouret E, Cauvin C, Fuentes S, et al. Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression. Spine J. 2015;15(5):944950.

    • Search Google Scholar
    • Export Citation
  • 7

    Bauer HC, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66(2):143146.

    • Search Google Scholar
    • Export Citation
  • 8

    Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005;30(19):21862191.

    • Search Google Scholar
    • Export Citation
  • 9

    Daniel JW, Veiga JCE. Prognostic parameters and spinal metastases: a research study. PLoS One. 2014;9(10):e109579.

  • 10

    Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine (Phila Pa 1976). 2001;26(3):298306.

  • 11

    Wibmer C, Leithner A, Hofmann G, et al. Survival analysis of 254 patients after manifestation of spinal metastases: evaluation of seven preoperative scoring systems. Spine (Phila Pa 1976). 2011;36(23):19771986.

    • Search Google Scholar
    • Export Citation
  • 12

    Choi D, Fox Z, Albert T, et al. Prediction of quality of life and survival after surgery for symptomatic spinal metastases: a multicenter cohort study to determine suitability for surgical treatment. Neurosurgery. 2015;77(5):698708.

    • Search Google Scholar
    • Export Citation
  • 13

    Tokuhashi Y, Matsuzaki H, Toriyama S, et al. Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 1990;15(11):11101113.

    • Search Google Scholar
    • Export Citation
  • 14

    van der Linden YM, Dijkstra SPDS, Vonk EJA, et al. Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer. 2005;103(2):320328.

    • Search Google Scholar
    • Export Citation
  • 15

    Rades D, Dunst J, Schild SE. The first score predicting overall survival in patients with metastatic spinal cord compression. Cancer. 2008;112(1):157161.

    • Search Google Scholar
    • Export Citation
  • 16

    Lei M, Li J, Liu Y, et al. Who are the best candidates for decompressive surgery and spine stabilization in patients with metastatic spinal cord compression? A new scoring system. Spine (Phila Pa 1976). 2016;41(18):14691476.

    • Search Google Scholar
    • Export Citation
  • 17

    Wright E, Ricciardi F, Arts M, et al. Metastatic spine tumor epidemiology: comparison of trends in surgery across two decades and three continents. World Neurosurg. 2018;114:e809e817.

    • Search Google Scholar
    • Export Citation
  • 18

    Sun J, Wei Q, Zhou Y, et al. A systematic analysis of FDA-approved anticancer drugs. BMC Syst Biol. 2017;11(5)(suppl 5):87.

  • 19

    Gakhar H, Swamy GN, Bommireddy R, et al. A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer. Eur Spine J. 2013;22(3):565568.

    • Search Google Scholar
    • Export Citation
  • 20

    Park S, Lee C, Chung S, Lee K. How accurately can Tokuhashi score system predict survival in the current practice for spinal metastases? Prospective analysis of 145 consecutive patients between 2007 and 2013. J Spinal Disord Tech. 2015;28(4):E219E224.

    • Search Google Scholar
    • Export Citation
  • 21

    Zoccali C, Skoch J, Walter CM, et al. The Tokuhashi score: effectiveness and pitfalls. Eur Spine J. 2016;25(3):673678.

  • 22

    Pollner P, Horváth A, Mezei T, et al. Analysis of four scoring systems for the prognosis of patients with metastasis of the vertebral column. World Neurosurg. 2018;112:e675e682.

    • Search Google Scholar
    • Export Citation
  • 23

    Dardic M, Wibmer C, Berghold A, et al. Evaluation of prognostic scoring systems for spinal metastases in 196 patients treated during 2005-2010. Eur Spine J. 2015;24(10):21332141.

    • Search Google Scholar
    • Export Citation
  • 24

    Eichler K, Jakobi S, Gruber-Rouh T, et al. Transarterial chemoembolisation (TACE) with gemcitabine: phase II study in patients with liver metastases of breast cancer. Eur J Radiol. 2013;82(12):e816e822.

    • Search Google Scholar
    • Export Citation
  • 25

    Liu Y, Du CX, Zhang HG. Analysis of the prognosis of 111 patients with gastric cancer or adenocarcinoma of the esophagogastric junction combined with pleural or abdominal effusion. Article in Chinese. Zhonghua Zhong Liu Za Zhi. 2013;35(9):693697.

    • Search Google Scholar
    • Export Citation
  • 26

    Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30(4):419425.

    • Search Google Scholar
    • Export Citation
  • 27

    Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643648.

    • Search Google Scholar
    • Export Citation
  • 28

    Lukasiewicz AM, Basques BA, Bohl DD, et al. Myelopathy is associated with increased all-cause morbidity and mortality following anterior cervical discectomy and fusion: a study of 5256 patients in American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Spine (Phila Pa 1976). 2015;40(7):443449.

    • Search Google Scholar
    • Export Citation
  • 29

    Varma A, Hill EG, Nicholas J, Selassie A. Predictors of early mortality after traumatic spinal cord injury: a population-based study. Spine (Phila Pa 1976). 2010;35(7):778783.

    • Search Google Scholar
    • Export Citation
  • 30

    Choi D, Crockard A, Bunger C, et al. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J. 2010;19(2):215222.

    • Search Google Scholar
    • Export Citation
  • 31

    Crnalic S, Löfvenberg R, Bergh A, et al. Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score. Spine (Phila Pa 1976). 2012;37(26):21682176.

    • Search Google Scholar
    • Export Citation
  • 32

    Rades D, Huttenlocher S, Bartscht T, Schild SE. Predicting the survival probability of gastric cancer patients developing metastatic epidural spinal cord compression (MESCC). Gastric Cancer. 2015;18(4):881884.

    • Search Google Scholar
    • Export Citation
  • 33

    Kumar N, Tan JJH, Zaw AS, et al. Evaluation of scoring systems and prognostic factors in patients with spinal metastases from nasopharyngeal carcinoma. Spine J. 2014;14(12):29462953.

    • Search Google Scholar
    • Export Citation
  • 34

    Amelot A, Terrier LM, Cristini J, et al. Survival in breast cancer patients with spine metastases: Prognostic assessment involving molecular markers. Eur J Surg Oncol. 2020;46(6):10211027.

    • Search Google Scholar
    • Export Citation
  • 35

    Amelot A, Terrier LM, Cristini J, et al. Spinal metastases from lung cancer: survival depends only on genotype, neurological and personal status, scarcely of surgical resection. Surg Oncol. 2020;34:5156.

    • Search Google Scholar
    • Export Citation
  • 36

    Cassidy JT, Baker JF, Lenehan B. The role of prognostic scoring systems in assessing surgical candidacy for patients with vertebral metastasis: a narrative review. Global Spine J. 2018;8(6):638651.

    • Search Google Scholar
    • Export Citation
  • 37

    Yao A, Sarkiss CA, Ladner TR, Jenkins AL III. Contemporary spinal oncology treatment paradigms and outcomes for metastatic tumors to the spine: a systematic review of breast, prostate, renal, and lung metastases. J Clin Neurosci. 2017;41:1123.

    • Search Google Scholar
    • Export Citation
  • 38

    Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221E1229.

    • Search Google Scholar
    • Export Citation
  • 39

    Lawton AJ, Lee KA, Cheville AL, et al. Assessment and management of patients with metastatic spinal cord compression: a multidisciplinary review. J Clin Oncol. 2019;37(1):6171.

    • Search Google Scholar
    • Export Citation
  • 40

    Taylor C, Munro AJ, Glynne-Jones R, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ. 2010;340:c951.

  • 41

    Heineman T, St John MA, Wein RO, Weber RS. It takes a village: the importance of multidisciplinary care. Otolaryngol Clin North Am. 2017;50(4):679687.

    • Search Google Scholar
    • Export Citation
  • 42

    Leithner A, Radl R, Gruber G, et al. Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J. 2008;17(11):14881495.

    • Search Google Scholar
    • Export Citation
  • 43

    Hibberd CS, Quan GMY. Accuracy of preoperative scoring systems for the prognostication and treatment of patients with spinal metastases. Int Sch Res Notices. 2017;2017:1320684.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 57 57 57
Full Text Views 36 36 36
PDF Downloads 53 53 53
EPUB Downloads 0 0 0