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.

Title

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.

Creator

Schoenfeld AJ; Ferrone ML; Blucher JA; Agaronnik N; Nguyen L; Tobert Daniel G; Balboni TA; Schwab JH; Shin JH; Sciubba DM; Harris MB

Publisher

The Spine Journal

Date

2021
2021-03-16

Description

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.

Subject

Decision-making; NESMS; Prognostic score; SINS; Spinal metastases; Survival; Tokuhashi; Tomita

Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Format

journalArticle

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ISSN

1878-1632 1529-9430

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NEOMED College of Medicine Student

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Update Year & Number

April 2021 List

Citation

Schoenfeld AJ; Ferrone ML; Blucher JA; Agaronnik N; Nguyen L; Tobert Daniel G; Balboni TA; Schwab JH; Shin JH; Sciubba DM; Harris MB, “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.,” NEOMED Bibliography Database, accessed October 17, 2021, https://neomed.omeka.net/items/show/11612.

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