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Assessment of survival prediction after surgery in spinal metastases patients using the Global Spine Study Tumor Group (GSTSG) risk calculator; an external validation from a tertiary cancer hospital

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Abstract

Purpose

We aim to validate the Global Spine Tumor Study Group (GSTSG) score compared to previous prognostic scoring systems in spinal metastasis.

Methods

We conducted a retrospective study from January 2013 to December 2022. The survival prediction was compared between the GSTSG, Tomita Score, Revised Tokuhashi Score, and Skeletal Oncology Research Group (SORG) Nomogram. Single-variable factors associated with survival rate were analyzed using univariate Cox regression and multivariable Cox proportional hazard model. Receiver operating characteristic was used for external validity analysis at 3, 6, 12, and 24 months. The overall survival rate was reported using the Kaplan–Meier survival curve.

Results

248 spinal metastasis patients were included. The mean age was 59.23 ± 12.55 years. The mean duration of follow-up time was 470.29 ± 441.98 days. The external validity of GSTSG was the highest at all follow-up times (sufficiently accurate AUC > 0.7), which was about the same as SORG at 3 months (both AUC of GSTSG and SORG = 0.76) and higher than modified Tokuhashi and Tomita score at 12 months (AUC of GSTSG = 0.78, SORG = 0.71, Tomita = 0.64, and modified Tokuhashi = 0.61, respectively).

Conclusion

From our study, the Multivariate Cox regression analysis indicates that the significant factors related to survival rate are regular analgesic use of weak opioids, lung metastasis, and previous chemotherapy. Compared to other traditional spinal metastases prognostic scoring systems, GSTSG shows the highest AUC for external validity in all follow-up times up to 24 months.

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Acknowledgements

We would like to thank Wishuda Udomwongsub for English language editing and Data Management Unit, Centre of Learning and Research in Celebration of HRH Princess Chulabhorn’s 60th Birthday Anniversary, Chulabhorn Royal Academy for Statistical Analysis.

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Authors and Affiliations

  1. Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand

    Warayos Trathitephun, Patcharapol Arunwatthanangkul, Nithi Pakmanee, Jackapol Kamolpak & Siravich Suvithayasiri

  2. Institute of Orthopedics, Lerdsin Hospital, Bangkok, Thailand

    Sasikarn Wanitchakorn

  3. Department of Diagnostic and Therapeutic Radiology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand

    Munthaparn Pichyangkul

  4. Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand

    Numfon Tweeatsani

  5. Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand

    Siravich Suvithayasiri

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  1. Warayos Trathitephun
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Contributions

Data collection: TW, AP, PN, WS, PM, TN; Methodology: TW, KJ, SS; Writing—original draft: TW; Writing—review & editing: TW, KJ, SS.

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Correspondence to Warayos Trathitephun.

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Trathitephun, W., Arunwatthanangkul, P., Pakmanee, N. et al. Assessment of survival prediction after surgery in spinal metastases patients using the Global Spine Study Tumor Group (GSTSG) risk calculator; an external validation from a tertiary cancer hospital. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08439-8

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