Department of Orthopedics and Traumatology, Faculty of Medicine and University Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.
Acta Neurochir (Wien). 2020 Jan;162(1):109-119. doi: 10.1007/s00701-019-04115-9. Epub 2019 Nov 28.
Prognostic scores have been proposed to guide the treatment of patients with metastatic spine disease (MSD), but their accuracy and usefulness are controversial. The aim of this study was to evaluate seven such prognostic scoring systems. The following prognostic scores were compared: Tomita, Van der Linden (VDL), Bauer modified (BM), Oswestry Spinal Risk Index (OSRI), Tokuhashi original (T90), Tokuhashi revised (TR05), and modified Tokuhashi revised (TR17).
We retrospectively reviewed all our patients who underwent surgery for spinal metastases, February 2008-January 2015. We classified all 223 patients into the predicted survival-time categories of each of the 7 scoring systems and then tallied how often this was correct vis-à-vis the actual survival time. Accuracy was also assessed using receiver operating characteristic (ROC) analysis at 1, 3, and 12 months.
The median (95% CI) survival of the 223 patients was 13.6 (7.9-19.3) months. A groupwise ROC analysis showed sufficient accuracy for 3-month survival only for TR17 (area under the curve [AUC] 0.71) and for 1-year survival for T90 (AUC 0.73), TR05 (AUC 0.76), TR17 (AUC 0.76), Tomita (AUC 0.77), and OSRI (AUC 0.71). A pointwise ROC score analysis showed poor prognostic ability for short-term survival (1 and 3 months) with sufficient accuracy for T90 (AUC 0.71), TR05 (AUC 0.71), TR17 (AUC 0.71), and the Tomita score (AUC 0.77) for 1-year survival.
The TR17 was the only prognostic system with acceptable performance here. More sophisticated assessment tools are required to keep up with present and future changes in tumor diagnostics and treatment.
已经提出了预后评分来指导转移性脊柱疾病（MSD）患者的治疗，但它们的准确性和实用性存在争议。本研究的目的是评估七种这样的预后评分系统。比较了以下预后评分：Tomita、Van der Linden（VDL）、Bauer 改良（BM）、Oswestry 脊柱风险指数（OSRI）、Tokuhashi 原始（T90）、Tokuhashi 修订（TR05）和改良 Tokuhashi 修订（TR17）。
我们回顾性地审查了所有在 2008 年 2 月至 2015 年 1 月期间因脊柱转移接受手术的患者。我们将所有 223 例患者分为每个评分系统的预测生存时间类别，然后计算实际生存时间与预测生存时间的相符程度。还使用接收器操作特征（ROC）分析在 1、3 和 12 个月时评估准确性。
223 例患者的中位（95%CI）生存时间为 13.6（7.9-19.3）个月。组间 ROC 分析显示，仅 TR17 对 3 个月的生存率具有足够的准确性（曲线下面积 [AUC] 0.71），T90 对 1 年生存率具有足够的准确性（AUC 0.73），TR05（AUC 0.76），TR17（AUC 0.76），Tomita（AUC 0.77）和 OSRI（AUC 0.71）。点值 ROC 评分分析显示短期生存率（1 和 3 个月）的预后能力较差，而 T90（AUC 0.71）、TR05（AUC 0.71）、TR17（AUC 0.71）和 Tomita 评分（AUC 0.77）具有 1 年生存率的准确性。
TR17 是唯一具有可接受性能的预后系统。需要更复杂的评估工具来跟上当前和未来肿瘤诊断和治疗的变化。
