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Analysis of seven prognostic scores in patients with surgically treated epidural metastatic spine disease

  • Original Article - Spine - Other
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Abstract

Background

Prognostic scores have been proposed to guide the treatment of patients with metastatic spine disease (MSD), but their accuracy and usefulness are controversial. The aim of this study was to evaluate seven such prognostic scoring systems. The following prognostic scores were compared: Tomita, Van der Linden (VDL), Bauer modified (BM), Oswestry Spinal Risk Index (OSRI), Tokuhashi original (T90), Tokuhashi revised (TR05), and modified Tokuhashi revised (TR17).

Methods

We retrospectively reviewed all our patients who underwent surgery for spinal metastases, February 2008–January 2015. We classified all 223 patients into the predicted survival-time categories of each of the 7 scoring systems and then tallied how often this was correct vis-à-vis the actual survival time. Accuracy was also assessed using receiver operating characteristic (ROC) analysis at 1, 3, and 12 months.

Results

The median (95% CI) survival of the 223 patients was 13.6 (7.9–19.3) months. A groupwise ROC analysis showed sufficient accuracy for 3-month survival only for TR17 (area under the curve [AUC] 0.71) and for 1-year survival for T90 (AUC 0.73), TR05 (AUC 0.76), TR17 (AUC 0.76), Tomita (AUC 0.77), and OSRI (AUC 0.71). A pointwise ROC score analysis showed poor prognostic ability for short-term survival (1 and 3 months) with sufficient accuracy for T90 (AUC 0.71), TR05 (AUC 0.71), TR17 (AUC 0.71), and the Tomita score (AUC 0.77) for 1-year survival.

Conclusion

The TR17 was the only prognostic system with acceptable performance here. More sophisticated assessment tools are required to keep up with present and future changes in tumor diagnostics and treatment.

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Acknowledgments

We thank Karim Heinlein (Centre of Orthopedic and Trauma Surgery, University Hospital, Cologne, Germany) for helping us with the management of data, and we would like to thank Angela Ernst, M.Sc., (Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Germany) for her invaluable help with the graphing options. We would also like to thank Michael Hanna, PhD, (Mercury Medical Research & Writing) for contributing to the revision of the manuscript after the initial journal review.

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Author notes

  1. Leonard Westermann and Alain C. Olivier contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Leonard Westermann, Alain Christoph Olivier, Peer Eysel, Krishnan Sircar & Kourosh Zarghooni

  2. Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany

    Christina Samel

  3. Department of Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany

    Christian Herren

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  1. Leonard Westermann
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Correspondence to Alain Christoph Olivier.

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Westermann, L., Olivier, A.C., Samel, C. et al. Analysis of seven prognostic scores in patients with surgically treated epidural metastatic spine disease. Acta Neurochir 162, 109–119 (2020). https://doi.org/10.1007/s00701-019-04115-9

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