Andrew J Schoenfeld1, Marco L Ferrone2, Justin A Blucher2, Nicole Agaronnik3, Lananh Nguyen2, Daniel G Tobert4, Tracy A Balboni5, Joseph H Schwab4, John H Shin6, Daniel M Sciubba7, Mitchel B Harris4. 1. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: ajschoen@neomed.edu. 2. Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. 3. Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. 4. Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. 5. Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. 6. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. 7. Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.
Abstract
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.
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.
Authors: Daryl R Fourney; Evan M Frangou; Timothy C Ryken; Christian P Dipaola; Christopher I Shaffrey; Sigurd H Berven; Mark H Bilsky; James S Harrop; Michael G Fehlings; Stefano Boriani; Dean Chou; Meic H Schmidt; David W Polly; Roberto Biagini; Shane Burch; Mark B Dekutoski; Aruna Ganju; Peter C Gerszten; Ziya L Gokaslan; Michael W Groff; Norbert J Liebsch; Ehud Mendel; Scott H Okuno; Shreyaskumar Patel; Laurence D Rhines; Peter S Rose; Daniel M Sciubba; Narayan Sundaresan; Katsuro Tomita; Peter P Varga; Luiz R Vialle; Frank D Vrionis; Yoshiya Yamada; Charles G Fisher Journal: J Clin Oncol Date: 2011-06-27 Impact factor: 44.544
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Authors: A Karim Ahmed; C Rory Goodwin; Amir Heravi; Rachel Kim; Nancy Abu-Bonsrah; Eric Sankey; Daniel Kerekes; Rafael De la Garza Ramos; Joseph Schwab; Daniel M Sciubba Journal: Spine J Date: 2018-03-19 Impact factor: 4.166
Authors: Michael G Fehlings; Anick Nater; Lindsay Tetreault; Branko Kopjar; Paul Arnold; Mark Dekutoski; Joel Finkelstein; Charles Fisher; John France; Ziya Gokaslan; Eric Massicotte; Laurence Rhines; Peter Rose; Arjun Sahgal; James Schuster; Alexander Vaccaro Journal: J Clin Oncol Date: 2015-11-23 Impact factor: 44.544
Authors: Grace X Xiong; Miles W A Fisher; Joseph H Schwab; Andrew K Simpson; Lananh Nguyen; Daniel G Tobert; Tracy A Balboni; John H Shin; Marco L Ferrone; Andrew J Schoenfeld Journal: Spine (Phila Pa 1976) Date: 2022-04-01 Impact factor: 3.468