title: Evaluation of prognostic scoring systems for spinal metastases in 196 patients treated during 2005-2010.
abstract: OBJECTIVE
  Estimating the survival time of patients with spinal metastases based on pre-treatment parameters is important for the best choice of therapy. Following two previous studies, this sequel analyzes possible changes in the impact of various parameters and scoring systems and includes a comparison to the previous dataset for the purpose to find the most predictive parameters and scores for this patient group.
  
  
  METHODS
  Included were 196 patients retrospectively with confirmed spinal metastases treated between 2005 and 2010 (35% surgery, 65% conservative). Possible prognostic factors [primary tumor, Karnofsky Performance Scale (KPS), visceral metastases, number of bone metastases, pathological fracture and neurologic status] and six scoring systems (Tokuhashi original/revised, Tomita, van der Linden, Bauer original and modified) were analyzed using Kaplan-Meier curves and Cox-regression models.
  
  
  RESULTS
  Median overall survival was 7 months with 9% of all patients alive at the time of analysis. Stepwise multivariate analysis showed significant influence on survival for visceral metastases (p<0.0001), primary tumor (p<0.0001), KPS (p<0.0001) and number of spinal metastases (p=0.0271). All scoring systems significantly predicted longer survival at a better score (absolute scores, p<0.001) in this dataset. Significant differentiation between the prognostic groups was seen only for the Tokuhashi original, the Bauer original and modified scores (p<0.001). In comparison to the previous dataset with varying age, gender and primary tumor distribution, the Bauer original and modified scores were the least influenced by the different patient collectives.
  
  
  CONCLUSIONS
  The Bauer modified score has shown consistent impact on predicting the remaining survival in patients with spinal metastases and is simultaneously simple in clinical use.
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Dardic
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria. christine.wibmer@medunigraz.at.
authors.forename: Christine
authors.initials: C
authors.lastname: Wibmer
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Berghold
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
authors.forename: L
authors.initials: L
authors.lastname: Stadlmueller
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
authors.forename: E V
authors.initials: EV
authors.lastname: Froehlich
authors.affiliation: Department of Orthopaedics and Orthopaedic Surgery, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Leithner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016103:Spinal Fractures / Q000209:etiology; D013125:Spinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D055815:Young Adult
keywords: Life expectancy; Prognostic scores; Spinal metastases; Spinal surgery
references.citation: Spine (Phila Pa 1976). 1990 Nov;15(11):1110-3
references.pmid: 1702559
references.citation: J Bone Joint Surg Br. 2005 May;87(5):698-703
references.pmid: 15855375
references.citation: Acta Orthop Scand. 1995 Apr;66(2):143-6
references.pmid: 7740944
references.citation: J Surg Oncol. 2013 Dec;108(7):499-503
references.pmid: 23982866
references.citation: Spine (Phila Pa 1976). 2011 May 15;36(11):910-7
references.pmid: 21037529
references.citation: Spine (Phila Pa 1976). 2005 Oct 1;30(19):2186-91
references.pmid: 16205345
references.citation: Cancer. 2013 Feb 15;119(4):897-903
references.pmid: 23065671
references.citation: Lancet Oncol. 2014 Jan;15(1):23-34
references.pmid: 24314615
references.citation: Spine (Phila Pa 1976). 2011 Nov 1;36(23):1977-86
references.pmid: 21304424
references.citation: Cancer. 2005 Jan 15;103(2):320-8
references.pmid: 15593360
references.citation: Paraplegia. 1969 Nov;7(3):179-92
references.pmid: 5360915
references.citation: Spine (Phila Pa 1976). 2003 Mar 1;28(5):508-12
references.pmid: 12616166
references.citation: Ann Surg Oncol. 2007 Feb;14(2):998-1004
references.pmid: 17083006
references.citation: Cancer. 1995 Oct 15;76(8):1453-9
references.pmid: 8620423
references.citation: J Cancer Res Clin Oncol. 2012 Feb;138(2):301-10
references.pmid: 22127369
references.citation: Eur Spine J. 2008 Nov;17(11):1488-95
references.pmid: 18787846
references.citation: Spine (Phila Pa 1976). 2001 Feb 1;26(3):298-306
references.pmid: 11224867
references.citation: Cancer. 2003 Jan 15;97(2):476-84
references.pmid: 12518372