Predictive Value Of Eight Prognostic Scoring Systems For Spinal Metastases

Objective: The aim of the present study was to compare the predictive value of eight widespread prognostic scoring systems to estimate both overall survival at various time points and tumorspecific survival for patients undergoing surgical treatment for metastatic spine disease in order to provide spinal surgeons with information to determine the most appropriate scoring system for a specific patient.Methods: A preoperative score for all 142 patients was retrospectively calculated utilizing Oswestry Spine Risk Index(OSRI),original Tokuhashi scoring system,revised Tokuhashi scoring system,Tomita scoring system,original Bauer scoring system,modified Bauer scoring system,Sioutos scoring system,and van der Linden scoring system.Univariate and multivariate Cox proportional hazard regression models were constructed to assess the association of patient’s clinical characteristics included in prognostic scoring systems and survival time.The Kappa value was used to evaluate the consistency of the survival rate of patients with spinal metastases predicted by each scoring system and the actual survival rate.Receiver Operating Characteristic curve(ROC)analysis modeling and Area Under Curve(AUC)were utilized to quantify the accuracy of each test at different end points and for different primary tumor subgroups.Results: Multivariate Cox proportional hazard regression analysis revealed that the growth rate of primary tumors([HR] 1.40,[95% CI 1.12-1.76,p = 0.004),visceral metastasis([HR] 1.24,[95% CI 1.00-1.52,p = 0.047)and general conditions([HR] 1.63,[95% CI 1.23-2.15,p = 0.001)are closely related to the survival time of patients with spinal metastases.The survival rate of patients with spinal metastases predicted by all scoring systems was inconsistent with the actual survival rate(Kappa value <0.40).Among all patients,the original Tokuhashi scoring system demonstrated the highest accuracy at predicting 3-months survival(AUC 0.72).OSRI(AUC0.70),revised Tokuhashi scoring system(AUC 0.71)and van der Linden scoring system(AUC0.71)also demonstrated moderate accuracy.In assessing the mid-term survival,only the original Tokuhashi scoring system(AUC 0.70)and the revised Tokuhashi scoring system(AUC 0.70)demonstrated moderate accuracy.In assessing the long-term survival,the accuracy of all scoring systems was poor(AUC <0.70).Conclusion: In this study,most of the scoring systems have ability to predict the short-term survival time of patients with spinal metastases,but the abilities to predict the mid-term and long-term survival time of patients are limited.The findings of the present study may be utilized by surgeons in a personalized effort to select the most appropriate scoring system for a given patient.