P29. Predicting tumor specific survival in patients with metastatic renal cell carcinoma: which scoring system is most accurate?

Abstract

BACKGROUND CONTEXT Renal cell carcinoma (RCC) is one of the most commonly diagnosed malignancies, with an estimated 74,000 new cases in 2019. Approximately 40% of bony metastasis occurs in the spine. Prognostic scoring systems predict the survival time of patients with spinal metastatic disease and guide spine surgeons with decision-making about the best treatment modality. PURPOSE This study aims to assess the performance of previously validated prediction models for spine metastatic disease to predict the survival of RCC patients. STUDY DESIGN/SETTING A multi-centric retrospective study PATIENT SAMPLE Included n=86 patients with spinal metastatic RCC. OUTCOME MEASURES Preoperative scores were calculated using: (1 Tomita, (2 original Tokuhashi, (3 revised Tokuhashi, (4 original Bauer, (5 modified Bauer, (6 Katagiri, (7 Van Der Linden, (8 SORG classic algorithm, (9 SORG nomogram, (10 New England spinal metastasis score (NESMS). METHODS Univariate Cox proportional hazard models were calculated to assess the association of patient variables with 1-year survival. The time-dependent ROC was performed for each model. Cutoffs for (AUC) are as follows: excellent (AUC ≥ 0.90), good (AUC ≥ 0.80 and ˂ 0.90), fair (AUC ≥ 0.70 and ˂ 0.80), and poor performance (AUC ˂ 0.70). RESULTS N=86 patients (60.90±11.36 years, 73.25% male) undergoing spine surgery for spinal metastatic RCC. Univariate analysis showed that patient and tumor factors were strongly associated with 1-year survival: (1 Poor KPS (HR:6.78 [95% CI:1.96–23.48]), (2 ECOG grade 3-4 (HR:3.52 [1.57-7.91]), (3 Frankel grade A-D (HR:2.54 [1.01-6.46]), (4 albumin CONCLUSIONS Most validated prognostic scores have a poor or fair performance in predicting the survival of RCC surgical patients with spinal metastatic disease. Tumor-specific factors and newer treatment modalities affect the survival of RCC patients and should be evaluated in future prognostic studies. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.