Schoenfeld Andrew J, Ferrone Marco L, Schwab Joseph H, Blucher Justin A, Barton Lauren B, Tobert Daniel G, Chi John H, Shin John H, Kang James D, Harris Mitchel B
Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Spine J. 2021 Jan;21(1):28-36. doi: 10.1016/j.spinee.2020.02.009. Epub 2020 Feb 19.
The New England Spinal Metastasis Score (NESMS) was proposed as an intuitive and accessible prognostic tool for predicting survival in patients with spinal metastases. We designed an appropriately powered, prospective, longitudinal investigation to validate the NESMS.
To prospectively validate the NESMS.
Prospective longitudinal observational cohort study.
Patients, aged 18 and older, presenting for treatment with spinal metastatic disease.
One-year mortality (primary); 6-month mortality and mortality at any time point following enrollment (secondary).
The date of enrollment was set as time zero for all patients. The NESMS was assigned based on data collected at the time of enrollment. Patients were prospectively followed to one of two predetermined end-points: death, or survival at 365 days following enrollment. Survival was visually assessed with Kaplan-Meier curves and then analyzed using multivariable logistic regression, followed by Bayesian regression to assess for robustness of point estimates and 95% confidence intervals (CI).
This study included 180 patients enrolled between 2017 and 2018. Mortality within 1-year occurred in 56% of the cohort. Using NESMS 3 as the referent, those with a score of 2 had significantly greater odds of mortality (odds ratio 7.04; 95% CI 2.47, 20.08), as did those with a score of 1 (odds ratio 31.30; 95% CI 8.82, 111.04). A NESMS score of 0 was associated with perfect prediction, as 100% of individuals with this score were deceased at 1-year. Similar determinations were encountered for mortality at 6-months and overall.
This study validates the NESMS and demonstrates its utility in prognosticating survival for patients with spinal metastatic disease, irrespective of selected treatment strategy. This is the first study to prospectively validate a prognostic utility for patients with spinal metastases. The NESMS can be directly applied to patient care, hospital-based practice and health-care policy.
新英格兰脊柱转移瘤评分（NESMS）被提议作为一种直观且易于使用的预后工具，用于预测脊柱转移瘤患者的生存期。我们设计了一项样本量充足的前瞻性纵向研究来验证NESMS。
前瞻性验证NESMS。
前瞻性纵向观察队列研究。
年龄在18岁及以上、因脊柱转移性疾病前来接受治疗的患者。
1年死亡率（主要指标）；6个月死亡率以及入组后任何时间点的死亡率（次要指标）。
将所有患者的入组日期设为时间零点。根据入组时收集的数据分配NESMS评分。对患者进行前瞻性随访，直至达到两个预定终点之一：死亡，或入组后365天存活。用Kaplan-Meier曲线直观评估生存率，然后使用多变量逻辑回归进行分析，接着采用贝叶斯回归评估点估计值和95%置信区间（CI）的稳健性。
本研究纳入了2017年至2018年期间入组的180例患者。该队列中1年内死亡率为56%。以NESMS 3为参照，评分为2的患者死亡几率显著更高（优势比7.04；95% CI 2.47，20.08），评分为1的患者也是如此（优势比31.30；95% CI 8.82，111.04）。NESMS评分为0与完美预测相关，因为该评分的患者1年时100%死亡。6个月时及总体死亡率也有类似结果。
本研究验证了NESMS，并证明了其在预测脊柱转移性疾病患者生存期方面的效用，无论所选治疗策略如何。这是第一项前瞻性验证脊柱转移瘤患者预后效用的研究。NESMS可直接应用于患者护理、医院实践和卫生保健政策。
