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Multicenter Study
. 2018 Dec 1;43(23):1678-1684.
doi: 10.1097/BRS.0000000000002576.

Prediction Accuracy of Common Prognostic Scoring Systems for Metastatic Spine Disease: Results of a Prospective International Multicentre Study of 1469 Patients

David Choi  1 , Federico Ricciardi  2 , Mark Arts  3 , Jacob M Buchowski  4 , Cody Bunger  5 , Chun Kee Chung  6 , Maarten Coppes  7 , Bart Depreitere  8 , Michael Fehlings  9 , Norio Kawahara  10 , Yee Leung  11 , Antonio Martin-Benlloch  12 , Eric Massicotte  9 , Christian Mazel  13 , Bernhard Meyer  14 , Cumhur Oner  15 , Wilco Peul  16 , Nasir Quraishi  17 , Yasuaki Tokuhashi  18 , Katsuro Tomita  10 , Christian Ulbricht  19 , Jorrit-Jan Verlaan  15 , Mike Wang  20 , Alan Crockard  1
Affiliations
Multicenter Study

Prediction Accuracy of Common Prognostic Scoring Systems for Metastatic Spine Disease: Results of a Prospective International Multicentre Study of 1469 Patients

David Choi et al. Spine (Phila Pa 1976). .

Abstract

Study design: A prospective multicenter cohort study.

Objective: To assess the clinical accuracy of six commonly cited prognostic scoring systems for patients with spinal metastases.

Summary of background data: There are presently several available methods for the estimation of prognosis in metastatic spinal disease, but none are universally accepted by surgeons for clinical use. These scoring systems have not been rigorously tested and validated in large datasets to see if they are reliable enough to inform day-to-day patient management decisions. We tested these scoring systems in a large cohort of patients. A total of 1469 patients were recruited into a secure internet database, and prospectively collected data were analyzed to assess the accuracy of published prognostic scoring systems.

Methods: We assessed six prognostic scoring systems, described by the first authors Tomita, Tokuhashi, Bauer, van der Linden, Rades, and Bollen. Kaplan-Meier survival estimates were created for different patient subgroups as described in the original publications. Harrell's C-statistic was calculated for the survival estimates, to assess the concordance between estimated and actual survival.

Results: All the prognostic scoring systems tested were able to categorize patients into separate prognostic groups with different overall survivals. However none of the scores were able to achieve "good concordance" as assessed by Harrell's C-statistic. The score of Bollen and colleagues was found to be the most accurate, with a Harrell's C-statistic of 0.66.

Conclusion: No prognostic scoring system was found to have a good predictive value. The scores of Bollen and Tomita were the most effective with Harrell's C-statistic of 0.66 and 0.65, respectively. Prognostic scoring systems are calculated using data from previous years, and are subject to inaccuracies as treatments advance in the interim. We suggest that other methods of assessing prognosis should be explored, such as prognostic risk calculation.

Level of evidence: 3.

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References

    1. 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; 19:215–222.
    1. Choi D, Crockard HA. How and why should we benchmark clinical outcomes and quality of life for surgery in spinal metastases? Br J Neurosurg 2009; 23:3–4.
    1. 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; 77:698–708.
    1. Nater A, Martin AR, Sahgal A, et al. Symptomatic spinal metastasis: a systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies. PLoS One 2017; 12:e0171507.
    1. Verlaan JJ, Choi D, Versteeg A, et al. Characteristics of patients who survived <3 months or >2 years after surgery for spinal metastases: can we avoid inappropriate patient selection? J Clin Oncol 2016; 34:3054–3061.

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