Prognostic scoring systems for spinal metastases in the era of anti-VEGF therapies.
METHODS
Spine Update on prognostic scoring systems for spinal metastases in the era of anti-vascular endothelial growth factor (VEGF) therapies.


OBJECTIVE
To review and discuss the strengths and weaknesses of available scoring systems since the introduction of molecular targeted anticancer agents.


BACKGROUND
Molecular targeted anticancer agents have dramatically improved survival of patients in various cancers, including renal cancer.


METHODS
Using prognostic scoring systems for spinal metastases and recent survival data of patients with cancers treated with anti-VEGF agents, a review was undertaken, evaluating the strengths and weaknesses of available prognostic scoring systems designed in the 1990s and early 2000s among patients treated with recent agents (available from 2005).


RESULTS
All available prognostic scoring systems for spinal metastases include the primary tumor as a key variable. The estimation of life expectancy with these systems is inaccurate in view of recent survival data, as illustrated in renal cancer. The underestimation of life expectancy and subsequent inadequate treatment of spinal metastases may lead to dramatic alteration of the quality of life.


CONCLUSIONS
The assessment of the available scores in recent cohorts of patients is mandatory to test their current validity and evidence the need for aggressive surgical management. New scoring systems taking into account the gain in survival induced by recent anticancer agents will likely be warranted in a close future.
Department of Orthopaedic Surgery, European Hospital Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Thomas M
TM
Gregory
Romain
R
Coriat
Olivier
O
Mir
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000068258:Bevacizumab; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D011379:Prognosis; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D013131:Spine / Q000473:pathology* / Q000601:surgery; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors / Q000378:metabolism
D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab