Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: which scoring system is most accurate?

Presented at the 2020 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

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  • 1 Departments of Neurosurgery,
  • 2 Orthopedic Surgery, and
  • 4 Radiation Oncology, Massachusetts General Hospital, Harvard Medical School;
  • 3 Massachusetts General Hospital Cancer Center, Harvard Medical School; and
  • 5 Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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OBJECTIVE

Although several prognostic scores for spinal metastatic disease have been developed in the past 2 decades, the applicability and validity of these models to specific cancer types are not yet clear. Most of the data used for model formation are from small population sets and have not been updated or externally validated to assess their performance. Developing predictive models is clinically relevant as prognostic assessment is crucial to optimal decision-making, particularly the decision for or against spine surgery. In this study, the authors investigated the performance of various spinal metastatic disease risk models in predicting prognosis for spine surgery to treat metastatic renal cell carcinoma (RCC).

METHODS

Data of patients who underwent surgery for RCC metastatic to the spine at 2 tertiary centers between 2010 and 2019 were retrospectively retrieved. The authors determined the prognostic value associated with the following scoring systems: the Tomita score, original and revised Tokuhashi scores, original and modified Bauer scores, Katagiri score, the Skeletal Oncology Research Group (SORG) classic algorithm and nomogram, and the New England Spinal Metastasis Score (NESMS). Regression analysis of patient variables in association with 1-year survival after surgery was assessed using Cox proportional hazard models. Calibration and time-dependent discrimination analysis were tested to quantify the accuracy of each scoring system at 3 months, 6 months, and 1 year.

RESULTS

A total of 86 metastatic RCC patients were included (median age 64 years [range 29–84 years]; 63 males [73.26%]). The 1-year survival rate was 72%. The 1-year survival group had a good performance status (Karnofsky Performance Scale [KPS] score 80%–100%) and an albumin level > 3.5 g/dL (p < 0.05). Multivariable-adjusted Cox regression analysis showed that poor performance status (KPS score < 70%), neurological deficit (Frankel grade A–D), and hypoalbuminemia (< 3.5 g/dL) were associated with a higher risk of death before 1 year (p < 0.05). The SORG nomogram, SORG classic, original Tokuhashi, and original Bauer demonstrated fair performance (0.7 < area under the curve < 0.8). The NESMS differentiates survival among the prognostic categories with the highest accuracy (area under the curve > 0.8).

CONCLUSIONS

The present study shows that the most cited and commonly used scoring systems have a fair performance predicting survival for patients undergoing spine surgery for metastatic RCC. The NESMS had the best performance at predicting 1-year survival after surgery.

ABBREVIATIONS AUC = area under the curve; ECOG = Eastern Cooperative Oncology Group; ESCC = epidural spinal cord compression; KPS = Karnofsky Performance Scale; mTOR = mammalian target of rapamycin; NESMS = New England Spinal Metastasis Score; RCC = renal cell carcinoma; ROC = receiver operating characteristic; SINS = Spine Instability Neoplastic Score; SORG = Skeletal Oncology Research Group; TKI = tyrosine kinase inhibitor.

Supplementary Materials

    • Supplemental Table 1 (PDF 449 KB)

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Contributor Notes

Correspondence John H. Shin: Massachusetts General Hospital, Boston, MA. shin.john@mgh.harvard.edu.

INCLUDE WHEN CITING Published online June 5, 2020; DOI: 10.3171/2020.4.SPINE20173.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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