Assessing the utility of a prognostication model to predict 1-year mortality in patients undergoing radiation therapy for spinal metastases

Abstract

Background ContextPredicting survival outcomes after radiation therapy (RT) alone for metastatic disease of the spine is a challenging task that is important to guiding treatment decisions (eg, determining dose fractionation and intensity). The New England Spinal Metastasis Score (NESMS) was recently introduced and validated in independent cohorts as a tool to predict 1-year survival following surgery for spinal metastases. This metric is composed of three factors: preoperative albumin, ambulatory status, and modified Bauer score, with the total score ranging from 0 to 3. PurposeThe purpose of this study was to assess the applicability of the NESMS model to predict 1-year survival among patients treated with RT alone for spinal metastases. Study Design/SettingThis study is a retrospective analysis. Patient SampleThis sample included 290 patients who underwent conventional RT alone for spinal metastases. Outcome MeasuresPatients' NESMS (composed of ambulatory status, pretreatment serum albumin, and modified Bauer score) were assessed, as well as their 1-year overall survival rates following radiation for metastatic disease of the spine. Materials and MethodsThis study is a single-institution retrospective analysis of 290 patients treated with conventional radiation alone for spinal metastases from 2008 to 2013. The predictive value of the NESMS was assessed using multivariable logistic regression modeling, adjusted for potential confounding variables. ResultsThis analysis indicated that patients with lower NESMSs had higher rates of 1-year mortality. Multivariable analysis demonstrated a strong association between lower NESMSs and lower rates of survival. ConclusionsThe NESMS is a simple prognostic scheme that requires clinical data that are often readily available and have been validated in independent cohorts of surgical patients. This study serves to validate the utility of the NESMS composite score to predict 1-year mortality in patients treated with radiation alone for spinal metastases.