title: Metastatic spinal cord compression: a validated survival score for elderly patients.
abstract: OBJECTIVE
  This study aimed to develop a validated survival score for elderly patients with metastatic spinal cord compression (MSCC).
  
  
  METHODS
  In all, 1,128 patients were randomly assigned to the test (n = 564) or validation group (n = 564). In the test group, ten pretreatment factors (age, gender, performance status, primary tumor, number of involved vertebrae, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, time to developing motor deficits) plus the radiation regimen were retrospectively evaluated. Factors significantly associated with survival on multivariate analysis were included in the survival score. The score for each factor was determined by dividing the 6-month survival rate (%) by 10. The prognostic score represented the sum of the scores for each factor.
  
  
  RESULTS
  In the multivariate analysis of the test group, age, performance status, primary tumor type, ambulatory status, other bone metastases, visceral metastases, interval from cancer diagnosis to radiotherapy of MSCC, and time to developing motor deficits were significantly associated with survival. Total scores ranged from 25 to 57 points. In the test group, 6-month survival rates were 11 % for 25-39 points, 56 % for 40-48 points, and 97 % for 49-57 points (p < 0.001). In the validation group, 6-month survival rates were 10, 53, and 94 %, respectively (p < 0.001).
  
  
  CONCLUSIONS
  Based on the survival scores of the test group, three prognostic groups were identified. The survival rates of the validation group were similar to the test group. This score appears reproducible and can help select the appropriate treatment for elderly patients with MSCC.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany, Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.forename: Jasmin N
authors.initials: JN
authors.lastname: Evers
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.forename: Theo
authors.initials: T
authors.lastname: Veninga
authors.forename: Johann H
authors.initials: JH
authors.lastname: Karstens
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary*; D015984:Causality; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D020266:Radiotherapy, Conformal / Q000401:mortality; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000401:mortality* / Q000532:radiotherapy*; D013120:Spinal Cord Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D016019:Survival Analysis; D016896:Treatment Outcome