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<a href="http://doi.org/10.1016/j.spinee.2021.03.007" target="_blank" rel="noreferrer noopener">http://doi.org/10.1016/j.spinee.2021.03.007</a>
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1878-1632 1529-9430
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April 2021 List
NEOMED College
NEOMED College of Medicine Student
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NEOMED Student Publications
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Title
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Prospective comparison of the accuracy of the New England spinal metastasis score (NESMS) to legacy scoring systems in prognosticating outcomes following treatment of spinal metastases.
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The Spine Journal
Date
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2021
2021-03-16
Subject
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Decision-making; NESMS; Prognostic score; SINS; Spinal metastases; Survival; Tokuhashi; Tomita
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Schoenfeld AJ; Ferrone ML; Blucher JA; Agaronnik N; Nguyen L; Tobert Daniel G; Balboni TA; Schwab JH; Shin JH; Sciubba DM; Harris MB
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BACKGROUND CONTEXT: We developed the New England Spinal Metastasis Score (NESMS) as a simple, informative, scoring scheme that could be applied to both operative and non-operative patients. The performance of the NESMS to other legacy scoring systems has not previously been compared using appropriately powered, prospectively collected, longitudinal data. PURPOSE: To compare the predictive capacity of the NESMS to the Tokuhashi, Tomita and Spinal Instability Neoplastic Score (SINS) in a prospective cohort, where all scores were assigned at the time of baseline enrollment. PATIENT SAMPLE: We enrolled 202 patients with spinal metastases who met inclusion criteria between 2017-2019. OUTCOME MEASURES: One-year survival (primary); 3-month mortality and ambulatory function at 3- and 6-months were considered secondarily. METHODS: All prognostic scores were assigned based on enrollment data, which was also assigned as time-zero. Patients were followed until death or survival at 365 days after enrollment. Survival was assessed using Kaplan-Meier curves and score performance was determined via logistic regression testing and observed to expected plots. The discriminative capacity (c-statistic) of the scoring measures were compared via the z-score. RESULTS: When comparing the discriminative capacity of the predictive scores, the NESMS had the highest c-statistic (0.79), followed by the Tomita (0.69), the Tokuhashi (0.67) and the SINS (0.54). The discriminative capacity of the NESMS was significantly greater (p-value range: 0.02 to <0.001) than any of the other predictive tools. The NESMS was also able to inform independent ambulatory function at 3- and 6-months, a function that was only uniformly replicated by the Tokuhashi score. CONCLUSIONS: The results of this prospective validation study indicate that the NESMS was able to differentiate survival to a significantly higher degree than the Tokuhashi, Tomita and SINS. We believe that these findings endorse the utilization of the NESMS as a prognostic tool capable of informing care for patients with spinal metastases.
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<a href="http://doi.org/10.1016/j.spinee.2021.03.007" target="_blank" rel="noreferrer noopener">10.1016/j.spinee.2021.03.007</a>
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journalArticle
2021
Agaronnik N
April 2021 List
Balboni TA
Blucher JA
Decision-making
Ferrone ML
Harris MB
journalArticle
NEOMED College of Medicine Student
NESMS
Nguyen L
Prognostic score
Schoenfeld AJ
Schwab JH
Sciubba DM
Shin JH
SINS
Spinal metastases
Survival
The Spine Journal
Tobert Daniel G
Tokuhashi
Tomita