Division of Medical Oncology, Department of Internal Medicine, Buddhasothorn Hospital, Chachoengsao, Thailand.
Asian Pac J Cancer Prev. 2022 Feb 1;23(2):623-630. doi: 10.31557/APJCP.2022.23.2.623.
Although many prognostic scoring systems have been used to predict survival of malignant spinal cord compression (MSCC) patients, some previous data have shown that the accuracy of the scoring system remains problematic. Current advanced cancer therapies may influence the altered survival predictions. The aim of this study was to develop a new prognostic scoring system for higher accuracy of survival prediction in patients with malignant spinal cord compression (MSCC).
Data were collected from 89 patients diagnosed with MSCC in 2018-2020. Potential clinical factors were analyzed using univariate and multivariate Cox's regression analysis. The selected logistic coefficients were transformed into a prognostic predictive scoring system. Internal validation was performed using the bootstrapping procedure.
According to multivariate Cox's regression analysis, 9 potential prognostic factors were obtained, i.e. Neutrophil-to-Lymphocyte ratio >3.6, breast cancer, lung cancer, other types of cancer (except prostate cancer), male, complete paralysis, spinal metastases in three levels, hypercalcemia, and no further systemic treatment. The data was developed into a Buddhasothorn Hospital Malignant Spinal Cord Compression (BSH-MSCC) score with an interval of 0-52 points (AUC = 0.77; AUC to predict short-term survival = 0.93). When using the cut-off point > 18 to predict short-term survival, AUC = 0.84, sensitivity = 81.5%, specificity = 85.7%, PPV = 89.8%, and NPV = 75.0%. Internal validation with 1,000 bootstrap resampling showed good discrimination.
BSH-MSCC score had a simplified score and high accuracy. The new tool is more accurate and can help decision-making for better treatment using a multidisciplinary approach.
尽管已有许多预后评分系统被用于预测恶性脊髓压迫症（MSCC）患者的生存情况，但一些先前的数据表明，评分系统的准确性仍存在问题。当前的先进癌症疗法可能会影响改变后的生存预测。本研究旨在开发一种新的预后评分系统，以提高恶性脊髓压迫症（MSCC）患者生存预测的准确性。
收集了 2018-2020 年期间 89 例诊断为 MSCC 的患者的数据。使用单变量和多变量 Cox 回归分析来分析潜在的临床因素。选择的逻辑系数被转化为预后预测评分系统。内部验证采用自举程序进行。
根据多变量 Cox 回归分析，获得了 9 个潜在的预后因素，即中性粒细胞与淋巴细胞比值>3.6、乳腺癌、肺癌、其他类型的癌症（前列腺癌除外）、男性、完全瘫痪、三个水平的脊柱转移、高钙血症和无进一步的全身治疗。数据被开发成一个 Buddhasothorn 医院恶性脊髓压迫症（BSH-MSCC）评分，分数范围为 0-52 分（AUC=0.77；预测短期生存的 AUC=0.93）。当使用>18 作为预测短期生存的截断值时，AUC=0.84，敏感性为 81.5%，特异性为 85.7%，PPV=89.8%，NPV=75.0%。1000 次自举重采样的内部验证显示了良好的区分度。
BSH-MSCC 评分具有简化的评分和较高的准确性。新工具更准确，可以帮助多学科方法进行更好的治疗决策。
