title: Reliability of a spinal metastasis prognostic score to model 1-year survival.
abstract: Predicting survival after surgery for patients with metastatic spine disease can be challenging, with multiple variables that can influence a patient's overall survival. Predictive models have been developed to assist clinicians in providing a prognosis for patients. Recently, Ghori et al. reported a composite model taking into account a modified Bauer score, preoperative albumin, and ambulatory status of patients with spinal metastasis. Using an independent cohort, we sought to assess the reliability and validity of this composite model to predict 1-year survival in patients diagnosed with metastatic cancer to the spine.
  
  
  
  This study aimed to assess the reliability and validity of the Ghori et al. composite model to predict 1-year survival in patients diagnosed with metastatic cancer to the spine, using an independent cohort.
  
  
  
  A retrospective study was carried out.
  
  
  
  The sample comprised 161 patients with spinal metastasis undergoing surgery.
  
  
  
  Patients' modified Bauer score, preoperative albumin, and ambulatory status were assessed.
  
  
  
  This study used a retrospective analysis of 161 patients with spinal metastasis who underwent surgical management from 2007 to 2013. The ability of this composite model to predict 1-year survival was compared with actual patient survival using multivariable logistic regression to control for confounders, as well as post-regression diagnostics.
  
  
  
  Our analysis revealed significantly lower 1-year mortality among patients with higher composite scores as compared with those with lower scores. Strong associations between scores and survival were appreciated in unadjusted analysis. The final model was able to account for 80% of the variation in the 1-year survival, and there was no evidence of lack of fit.
  
  
  
  This study demonstrates, in an independent cohort of spinal metastases patients, that a composite model taking into account the ambulatory status, serum albumin, and modified Bauer score is able to better predict postoperative survival. These data serve to validate the use of this predictive model in determining the prognosis of patients with spinal metastasis.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA. Electronic address: rory@jhmi.edu.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Abu-Bonsrah
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Tomas
authors.initials: T
authors.lastname: Garzon-Muvdi
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Sankey
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD 21287, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Ambulatory status; Metastases; Modified Bauer score; Prognosis; Spine surgery; Survival