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Evidence reviews for prognostic tools – overall survival
Spinal metastases and metastatic spinal cord compression
Evidence review L
NICE Guideline, No. 234
London: National Institute for Health and Care Excellence (NICE); 2023 Sep.
ISBN-13: 978-1-4731-5322-6
Copyright © NICE 2023.
Prognostic tools - overall survival
Review question
What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?
Introduction
Prognostic scores to estimate survival have been proposed to help inform treatment choices for people with spinal cord compression and spinal metastases. The aim of this review was to evaluate these scoring systems by summarising the accuracy of their survival predictions.
Summary of the protocol
See Table 1 for a summary of the Population, Index test (clinical prediction model) and Out-come (PIO) characteristics of this review.
For further details see the review protocol in appendix A.
Methods and process
This evidence review was developed using the methods and process described in Developing NICE guidelines: the manual. Methods specific to this review question are described in the review protocol in appendix A and the methods document (supplementary document 1).
Declarations of interest were recorded according to NICE’s conflicts of interest policy.
Prognostic evidence
Included studies
Twenty-five studies were included for this review, all were retrospective cohort studies (Ahmed 2018, Balain 2013, Denisov 2020, Eap 2015, Gakhar 2012, Gruenberg 2017, Iinuma 2021, Kumar 2014, Mollahoseini 2011, Park 2015, Pelegrini de Almeida 2018, Petteys 2015, Quraishi 2013, Ribas 2016, Tabourel 2021, Tabouret 2015, Tan 2016a, Tan 2016b, Tan 2018, Ulmar 2007, Wang 2012, Westerman 2020, Yang 2021, Yeung 2014, Yu 2015).
These studies reported the following prognostic tools for predicting survival: Bauer, Lei, Modified Bauer, Modified Tokuhashi revised, Oswestry Spinal Metastasis Risk Index, Rades, Revised Tokuhashi, SORG Classic scoring algorithm, SORG nomogram, SORG-ML, SSG, Tokuhashi, Tomita, and Van der Linden.
Seventeen studies were in patients undergoing surgery for spinal metastases (Ahmed 2018, Eap 2015, Gakhar 2013, Gruenberg 2017, Iinuma 2021, Park 2015, Pelegrini de Almeida 2018, Petteys 2015, Quraishi 2013, Ribas 2016, Tabourel 2021, Tabouret 2015, Wang 2012, Westermann 2020, Yang 2021, Yeung 2014, Yu 2015).
Eight studies were in patients with spinal metastases (Balain 2013, Denisov 2020, Kumar 2014, Mollahoseini 2011, Tan 2016a, Tan 2016b, Tan 2018, Ulmar 2007).
Two studies were in people with nasopharyngeal carcinoma (Kumar 2014, Tan 2016a), 2 in people with lung cancer (Tan 2016b, Yu 2015), 1 in renal cell cancer (Petteys 2015), 1 in breast cancer (Tan 2018) and the remaining 19 in people with any primary (Ahmed 2018, Balain 2013, Denisov 2020, Eap 2015, Gakhar 2012, Gruenberg 2017, Iinuma 2021, , Mollahoseini 2011, Park 2015, Pelegrini de Almeida 2018, Quraishi 2013, Ribas 2016, Tabourel 2021, Tabouret 2015, Ulmar 2007, Wang 2012, Westerman 2020, Yang 2021, Yeung 2014).
The studies were carried out in the USA (Ahmed 2018, Petteys 2015), UK (Balain 2013, Gakhar 2013, Quraishi 2013), Germany (Ulmar 2007, Westermann 2020), Denmark (Wang 2012), France (Eap 2015, Tabourel 2021, Tabouret 2015), Russia (Denisov 2020), Argentina (Guenberg 2017), Brazil (Pelegrini de Almeida 2018, Ribas 2016), Singapore (Kumar 2014, Tan 2016a, Tan 2016b, Tan 2018), Japan (Iinuma 2021), Taiwan (Yang 2021), China (Yeung 2014, Yu 201), Iran (Mollahoseini 2011), and Korea (Park 2015).
The included studies are summarised in Table 2.
See the literature search strategy in appendix B and study selection flow chart in appendix C.
Excluded studies
Studies not included in this review are listed, and reasons for their exclusion are provided in appendix K.
Summary of included studies
Summaries of the studies that were included in this review are presented in Table 2.
See the evidence tables in appendix D, the forest plots in appendix E and study data in appendix L.
Summary of the evidence
Evidence about the overall predictive accuracy of the scoring systems was summarised using the area under the ROC curve (AUC) statistic. AUC ranges from 0 to 1.0, where a value of 0.5 suggests no predictive accuracy and 1.0 indicates perfect predictive accuracy. AUC values above 0.70 could be considered acceptable and can be interpreted as: when presented with 2 random patients the scoring system will correctly identify the patient with poorer prognosis 70% of the time.
Several scoring systems had been validated in multiple studies. These gave estimates of AUC of 0.58 for Bauer, 0.5 to 0.71 for Modified Bauer, 0.69 Katagiri, 0.32 to 0.67 Oswestry Spinal Metastasis Risk Index, 0.74 Tokuhashi, 0.48 to 0.82 Revised Tokuhashi, 0.70 Modified Revised Tokuhashi, 0.38 to 0.77 Tomita and 0.68 Van der Linden scoring systems. The evidence quality for these ranged from very low to moderate.
Several other scoring systems had relatively high AUC but had only been validated in one study. These were SORG-ML, SORG Classic Scoring Algorithm and SORG nomogram. The evidence quality for these ranged from very low to high.
The AUC statistic, however, does not give an indication of how useful the scoring system will be in practice. To be used clinically the scoring systems use threshold scores to divide patients into groups based on their prognosis. The Revised Tokuhashi for example has three groups with expected survival of 6 months or less, 6 to 12 months and more than 12 months respectively. Evidence about the accuracy of these prognostic groups was also summarized (see appendix E for Forest plots and appendix F for full GRADE tables) – by calculating the proportion of patients within each prognostic group whose survival was accurately predicted by each scoring system.
Taking the Revised Tokuhashi Score as an example:
- In the group predicted to survive 6 months or less, 54% survived 6 months or less
- In the group predicted to survive 6 to 12 months, 34% survived between 6 to 12 months (but no longer)
- In the group predicted to survive more than 12 months, 78% survived more than 12 months
There was considerable variation between studies but overall the evidence suggests the scoring systems are an imperfect way to classify patients into prognostic groups. In general survival predictions in the best and worst prognostic groups were more accurate than in the intermediate groups. The evidence quality for these outcomes was very low to moderate.
See appendix F for full GRADE tables.
Economic evidence
Included studies
A systematic review of the economic literature was conducted but no economic studies were identified which were applicable to this review question.
A single economic search was undertaken for all topics included in the scope of this guideline. See supplement 2 for details.
Excluded studies
Economic studies not included in this review are listed, and reasons for their exclusion are provided in supplement 2.
Economic model
No economic modelling was undertaken for this review because the committee agreed that other topics were higher priorities for economic evaluation.
The committee’s discussion and interpretation of the evidence
The outcomes that matter most
The critical outcome for this review was accuracy of the scoring system for predicting overall survival. Some patients with metastatic spinal disease are frail with poor health and an assessment of likely prognosis is an important consideration when deciding on complex surgery and other treatments. The committee thought that these scoring systems might also be able to predict outcomes which correlate with prognosis including pain, event-free survival, duration of survival, neurological and functional status and quality of life. The accuracy of these predictions was an important outcome.
The quality of the evidence
The quality of the evidence was assessed using GRADE and ranged from very low to high. This was predominantly due to imprecision and serious heterogeneity unresolved by sub-group analysis. In addition, some of the studies were at serious risk of bias and some had populations that were indirectly relevant due to only including patients with a specific type of cancer.
No evidence was found on the accuracy of the scoring systems to predict pain, event-free survival, neurological and functional status and quality of life.
As a result of the uncertainty in the evidence the committee relied on their experience and expertise of using the scoring systems when making recommendations.
Benefits and harms
Based on the evidence and their experience the committee recommended the use of validated scoring systems with good evidence of accuracy and gave the Revised Tokuhashi scoring system as an example. The committee discussed how accurate assessment of prognosis should lead to better treatment decisions and ultimately improve quality of life, for example people with spinal metastases without MSCC (who have non-mechanical spinal pain) with a better prognosis have a higher likelihood to benefit from stereotactic ablative body radiotherapy than those with a poorer prognosis (see evidence review M). Although low quality evidence indicated that the Revised Tokuhashi scoring system was not very accurate in predicting those who would survive less than 1 year there was moderate quality evidence showing moderate accuracy in identifying those with better long-term prognosis. This was why they recommended the Revised Tokuhashi scoring system as a example, however they acknowledged that other scoring systems (such as the SORG and SSG algorithms) being developed and improved and show moderate accuracy but do not yet have the same weight of evidence as the Revised Tokuhashi. The committee noted that SORG utilises AI and may therefore be a tool that may become more widely used. However, there was only 1 study so whilst the did not to specifically name it in the recommendation, they also did not rule it out.
The committee also discussed whether they should recommend against the use of some of the scoring systems that had relatively low accuracy. However, they decided not to do this because there are ongoing revisions to various systems and this may improve those that are currently less accurate. Having a recommendation against their use may then cause confusion.
The committee noted that there was variation in accuracy, but discussed that scoring systems have a role in thinking about prognosis and informing decisions about treatment (both oncological and surgical) because they formalise and standardise information on key factors which can then be recorded and audited. They also acknowledged that the scoring systems had modest accuracy at best (AUC > 0.70 and <0.90). With the exception of the best prognosis category, their categorical predictions of survival were more often wrong than right. It was discussed that decisions about how long someone is likely to survive are complex and many other factors need to be taken into account that are unique to every person. So the committee agreed that clinicians should not take the number on a scoring system as a determining factor in isolation. To avoid decisions being made purely on a number resulting from a scoring system and encourage an individualised assessment, the committee recommended that they should not be used in isolation but alongside consideration of other clinical and personal factors.
Cost effectiveness and resource use
The recommendations mirror current practice where scoring scales are already widely used to assess prognosis. In the small number of cases where these systems are not in place the recommendations should lead to better decision making around treatments potentially avoiding inappropriate and costly treatments. This will reduce costs and improve quality of life for people with MSCC.
Recommendations supported by this evidence review
This evidence review supports recommendations 1.9.2 and 1.9.3 in the NICE guideline.
References – included studies
Ahmed, 2018
Ahmed A, Goodwin C, Heravi A, et al. Predicting survival for metastatic spine disease: a comparison of nine scoring systems. Spine Journal, 18, 1804–1814, 2018 [PubMed: 29567516]Balain, 2013
Balain B, Jaiswal A, Trivedi J, et al. The Oswestry Risk Index: an aid in the treatment of metastatic disease of the spine. Bone and Joint Journal, 95b, 210–6, 2013 [PubMed: 23365031]Denisov, 2020
Denisov A, Zaborovsky N, Ptashnikov D, et al. A Comparison of prognostic scales for patients with metastatic spine disease. Orthopedic Reviews, 12, 8822, 2020 [PMC free article: PMC7874951] [PubMed: 33585023]Eap, 2015
Eap C, Tardieux E Goasgen O, et al. Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases. Orthopaedics and Traumatology, Surgery and Research, 2015, 101, 483–8, 2015 [PubMed: 25910701]Gakhar, 2013
Gakhar H, Swamy G, Bommireddy R, et al. A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer. European Spine Journal, 22, 565–8, 2013 [PMC free article: PMC3585654] [PubMed: 22899107]Gruenberg, 2017
Gruenberg M, Mereles M, Willhuber G, et al. Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease. Global Spine Journal; 2017, 260–265, 2017 [PMC free article: PMC5476355] [PubMed: 28660109]Kumar, 2014
Kumar N, Tan J, Zaw A, et al. Evaluation of scoring systems and prognostic factors in patients with spinal metastases from nasopharyngeal carcinoma. Spine Journal, 14, 46–53, 2014 [PubMed: 24912121]Iinuma, 2021
Iinuma M, Akazawa T, Torii Y, et al. Optimization of the revised tokuhashi scoring system: New prognostic criteria for metastatic spinal tumor in surgical cases. Spine Surgery and Related Research, 5, 81–85, 2021 [PMC free article: PMC8026203] [PubMed: 33842714]Mollahoseini, 2011
Mollahoseini R, Farhan F, Khajoo A, et al. Is Tokuhashi score suitable for evaluation of life expectancy before surgery in iranian patients with spinal metastases? Journal of Research in Medical Sciences, 16, 1183–1188, 2011 [PMC free article: PMC3430043] [PubMed: 22973387]Park, 2015
Park S, Lee C, Chung S, et al. How Accurately Can Tokuhashi Score System Predict Survival in the Current Practice for Spinal Metastases? Journal of Spinal Disorders and Techniques, 28, e219–e224, 2015 [PubMed: 25393667]Pelegrini de Almeida, 2018
Pelegrini de Almeida L, Vidaletti T, Martins de Lima C, at al. Reliability of Tokuhashi Score to Predict Prognosis: Comparison of 117 Patients. World Neurosurgery, 111, e1–e6, 2018 [PubMed: 29175570]Petteys, 2015
Petteys R, Spitz S, Rhee J, et al. Tokuhashi score is predictive of survival in a cohort of patients undergoing surgery for renal cell carcinoma spinal metastases. European Spine Journal, 24, 2142–9, 2015 [PubMed: 25772089]Quraishi, 2013
Quraishi N, Manoharan S, Arealis G, et al. Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). European Spine Journal, 22, 21–6, 2013 [PMC free article: PMC3578515] [PubMed: 23328875]Ribas, 2016
Ribas E, Mathias Junior L, Guirado V, et al. Survival score scales of patients operated with spinal metastases: retrospective application in a Brazilian population. Arquivos de neuro-psiquiatria, 74, 44–9, 2016 [PubMed: 26602195]Tabourel, 2021
Tabourel G, Terrier L, Dubory A, et al. Are spine metastasis survival scoring systems outdated and do they underestimate life expectancy? Caution in surgical recommendation guidance. Journal of Neurosurgery – Spine, 35, 527–534, 2021 [PubMed: 34298515]Tabouret, 2015
Tabouret E, Cauvin C, Fuentes S, et al. Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression. Spine Journal, 15, 944–50, 2015 [PubMed: 24120144]Tan, 2016
Tan J, Zaw A, Malhotra R, et al. Survival prognostication in patients with skeletal metastases from nasopharyngeal carcinoma: An evaluation of the Scandinavian sarcoma group, Katagiri and Bauer scoring systems. Annals of the Academy of Medicine Singapore, 45, 51–60, 2016 [PubMed: 27125346]Tan, 2016
Tan J, Tan K, Zaw A, et al. Evaluation of Scoring Systems and Prognostic Factors in Patients With Spinal Metastases From Lung Cancer. Spine, 41, 638–44, 2016 [PubMed: 27018903]Tan, 2018
Tan K, Tan J, Zaw A, et al. Evaluation of Prognostic Factors and Proposed Changes to the Modified Tokuhashi Score in Patients With Spinal Metastases From Breast Cancer. Spine, 43, 512–519, 2018 [PubMed: 28749856]Ulmar, 2007
Ulmar, B, Huch, K, Naumann U, et al. Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases. European Journal of Surgical Oncology, 33, 914–9, 2007 [PubMed: 17210240]Wang, 2012
Wang M, Bunger C, Li H, et al. Predictive value of Tokuhashi scoring systems in spinal metastases, focusing on various primary tumor groups: evaluation of 448 patients in the Aarhus spinal metastases database. Spine, 37, 573–8, 2012 [PubMed: 21796024]Westermann, 2020
Westermann L, Olivier A, Samel C, et al. Analysis of seven prognostic scores in patients with surgically treated epidural metastatic spine disease. Acta Neurochirurgica, 162, 109–11, 2020 [PubMed: 31781995]Yang, 2021
Yang J, Chen C, Fourman M, et al. International external validation of the SORG machine learning algorithms for predicting 90-day and one-year survival of patients with spine metastases using a Taiwanese cohort. Spine Journal, 21, 1670–16, 2021 [PubMed: 33545371]Yeung, 2014
Yeung Y, Cheung K, Lam T, et al. A Study of the Predictive Value of the Modified Tokuhashi Score in Metastatic Spinal Tumour Causing Cord Compression in a Southern Chinese Population; Journal of Orthopaedics, Trauma and Rehabilitation, 18, 15–21, 2014Yu, 2015
Yu W, Tang L, Lin F, et al. Accuracy of Tokuhashi score system in predicting survival of lung cancer patients with vertebral metastasis. Journal of Neuro-oncology, 125, 427–33, 2015 [PubMed: 26376655]
Prognostic
Appendices
Appendix A. Review protocols
Appendix B. Search strategy (clinical/economic)
Appendix C. Prognostic evidence study selection
Appendix D. Evidence tables
Appendix E. Forest plots
Appendix F. Modified GRADE tables
Appendix G. Economic evidence study selection
Study selection for: What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?
No economic evidence was identified which was applicable to this review question.
Appendix H. Economic evidence tables
Economic evidence tables for review question: What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?
No evidence was identified which was applicable to this review question.
Appendix I. Economic model
Economic model for review question: What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?
No economic analysis was conducted for this review question.
Appendix J. Excluded studies
Excluded studies for review question: What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?
Excluded prognostic studies
Table 19Excluded studies and reasons for their exclusion
| Study | Reason for exclusion |
|---|---|
| Abbouchie, Hussein, Chao, Michael, Tacey, Mark et al. (2020) Vertebral fractures following stereotactic body radiotherapy for spine metastases. Journal of medical imaging and radiation oncology 64(2): 293–302 [PubMed: 32174019] | Outcomes do not match protocol |
| Afsar, Afifa; Qadeer, Mohsin; Sharif, Salman (2017) Surgically treated spinal metastases: Do prognostic scores have a role?. Surgical neurology international 8: 158 [PMC free article: PMC5535510] [PubMed: 28808607] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Aiba, Hisaki, Kimura, Tomoki, Yamagami, Takaya et al. (2016) Prediction of skeletal-related events in patients with non-small cell lung cancer. Supportive care in cancer: (8): 3361–7 [PubMed: 26980332] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Amelot, A., Cristini, J., Salaud, C. et al. (2017) Overall survival in spine myeloma metastases: Difficulties in predicting with prognostic scores. Spine 42(6): 400–406 [PubMed: 27390916] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Anonymous. (2022) Erratum to: Validation and simplification of a score predicting survival in patients irradiated for metastatic spinal cord compression (Cancer, 116, 15, (3670-3673), 10.1002/cncr.25223). Cancer 128(3): 633–634 [PubMed: 20564129] | Other protocol criteria - not a validated scoring system |
| Anzuategui, Pedro Reggiani, Cunha, Luiz Antonio Munhoz da, Mello, Glauco Jose Pauka et al. (2019) Spinal Metastasis Surgery: A Proposal for a Predictive Model of Morbidity and Mortality. Revista brasileira de ortopedia 54(6): 665–672 [PMC free article: PMC6923646] [PubMed: 31875065] | Other protocol criteria - not a validated scoring system |
| Aoude, A, Fortin, M, Aldebeyan, Sulta et al. (2018) The revised Tokuhashi score; analysis of parameters and assessment of its accuracy in determining survival in patients afflicted with spinal metastasis. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 27(4): 835–840 [PubMed: 28012079] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Aoude, Ahmed and Amiot, Louis-Philippe (2014) A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis. Canadian journal of surgery. Journal canadien de chirurgie 57(3): 188–93 [PMC free article: PMC4035401] [PubMed: 24869611] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Armstrong, Terri S, Gning, Ibrahima, Mendoza, Tito R et al. (2010) Reliability and validity of the M. D. Anderson Symptom Inventory-Spine Tumor Module. Journal of neurosurgery. Spine 12(4): 421–30 [PubMed: 20367379] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Atkinson, R.A., Davies, B., Jones, A. et al. (2016) Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site infection. Journal of Hospital Infection 94(1): 80–85 [PubMed: 27444231] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Balagamwala, Ehsan H, Miller, Jacob A, Reddy, Chandana A et al. (2018) Recursive partitioning analysis is predictive of overall survival for patients undergoing spine stereotactic radiosurgery. Journal of neuro-oncology 137(2): 289–293 [PubMed: 29299738] | Publication type does not match protocol - conference abstract |
| Bartels, R.H.M.A., Feuth, T., Rades, D. et al. (2011) External validation of a model to predict the survival of patients presenting with a spinal epidural metastasis. Cancer and Metastasis Reviews 30(2): 153–159 [PubMed: 21259121] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Bartels, Ronald H M A, de Ruiter, Godard, Feuth, Ton et al. (2016) Prediction of life expectancy in patients with spinal epidural metastasis. Neuro-oncology 18(1): 114–8 [PMC free article: PMC4677416] [PubMed: 26254478] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Bollen L, Wibmer C, Van der Linden Y, et al. Predictive Value of Six Prognostic Scoring Systems for Spinal Bone Metastases: An Analysis Based on 1379 Patients. Spine, 41, e155–62, 2016 [PubMed: 26866742] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Bollen, Laurens, Groenen, Karlijn, Pondaag, Willem et al. (2017) Clinical Evaluation of the Spinal Instability Neoplastic Score in Patients Treated With Radiotherapy for Symptomatic Spinal Bone Metastases. Spine 42(16): e956–e962 [PubMed: 28800570] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Bongers, Michiel E R, Karhade, Aditya V, Villavieja, Jemma et al. (2020) Does the SORG algorithm generalize to a contemporary cohort of patients with spinal metastases on external validation?. The spine journal : official journal of the North American Spine Society 20(10): 1646–1652 [PubMed: 32428674] | Other protocol criteria - not a validated scoring system |
| Buergy, Daniel, Siedlitzki, Lena, Boda-Heggemann, Judit et al. (2016) Overall survival after reirradiation of spinal metastases - independent validation of predictive models. Radiation oncology (London, England) 11: 35 [PMC free article: PMC4782309] [PubMed: 26951042] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Cai, Zhenyu, Tang, Xiaodong, Yang, Rongli et al. (2019) Modified score based on revised Tokuhashi score is needed for the determination of surgical intervention in patients with lung cancer metastases to the spine. World journal of surgical oncology 17(1): 194 [PMC free article: PMC6862838] [PubMed: 31739788] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Carrwik, Christian; Olerud, Claes; Robinson, Yohan (2020) Predictive Scores Underestimate Survival of Patients With Metastatic Spine Disease: A Retrospective Study of 315 Patients in Sweden. Spine 45(6): 414–419 [PubMed: 31651680] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Chang, Sam Yeol, Ha, Jae Hong, Seo, Sang Gyo et al. (2018) Prognosis of Single Spinal Metastatic Tumors: Predictive Value of the Spinal Instability Neoplastic Score System for Spinal Adverse Events. Asian spine journal 12(5): 919–926 [PMC free article: PMC6147885] [PubMed: 30213176] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Chantharakhit, Chaichana and Sujaritvanichpong, Nantapa (2022) Prognostic Scoring System Development for Malignant Spinal Cord Compression. Asian Pacific journal of cancer prevention : APJCP 23(2): 623–630 [PMC free article: PMC9272602] [PubMed: 35225475] | Other protocol criteria - not a validated scoring system |
| Chao, Samuel T, Koyfman, Shlomo A, Woody, Neil et al. (2012) Recursive partitioning analysis index is predictive for overall survival in patients undergoing spine stereotactic body radiation therapy for spinal metastases. International journal of radiation oncology, biology, physics 82(5): 1738–43 [PubMed: 21489717] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Chen, Huajiang, Xiao, Jianru, Yang, Xinghai et al. (2010) Preoperative scoring systems and prognostic factors for patients with spinal metastases from hepatocellular carcinoma. Spine 35(23): e1339–46 [PubMed: 20938387] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Chen, Qing, Chen, Xiaohui, Zhou, Lei et al. (2021) The emergence of new prognostic scores in lung cancer patients with spinal metastasis: A 12-year single-center retrospective study. Journal of Cancer 12(18): 5644–5653 [PMC free article: PMC8364647] [PubMed: 34405024] | Other protocol criteria - not a validated scoring system |
| Chen, S., Yang, M., Zhong, N. et al. (2021) Quantified CIN Score From Cell-free DNA as a Novel Noninvasive Predictor of Survival in Patients With Spinal Metastasis. Frontiers in Cell and Developmental Biology 9: 767340 [PMC free article: PMC8696126] [PubMed: 34957099] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Choi, D., Ricciardi, F., Arts, M. et al. (2018) Prediction accuracy of common prognostic scoring systems for metastatic spine disease. Spine 43(23): 1678–1684 [PubMed: 30422958] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Choi, David, Pavlou, Menelaos, Omar, Rumana et al. (2019) A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large prospective patient database to personalise surgical management. European journal of cancer (Oxford, England : 1990) 107: 28–36 [PubMed: 30529900] | Other protocol criteria - not a validated scoring system |
| Chow, Edward; Harris, Kristin; Fung, Kinwah (2006) Successful validation of a survival prediction model in patients with metastases in the spinal column. International journal of radiation oncology, biology, physics 65(5): 1522–7 [PubMed: 16750311] | Other protocol criteria - not a validated scoring system |
| Cook, William H and Baker, Joseph F (2020) Retrospective evaluation of prognostic factors in metastatic spine disease: serum albumin and primary tumour type are key. ANZ journal of surgery 90(6): 1070–1074 [PubMed: 32175660] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Crnalic, Sead, Lofvenberg, Richard, Bergh, Anders et al. (2012) Predicting survival for surgery of metastatic spinal cord compression in prostate cancer: a new score. Spine 37(26): 2168–76 [PubMed: 22648028] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Cui, Yunpeng, Lei, Mingxing, Pan, Yuanxing et al. (2020) Scoring Algorithms for Predicting Survival Prognosis in Patients With Metastatic Spinal Disease: The Current Status and Future Directions. Clinical spine surgery 33(8): 296–306 [PubMed: 32604194] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Dakson, Ayoub, Leck, Erika, Brandman, David M et al. (2020) The clinical utility of the Spinal Instability Neoplastic Score (SINS) system in spinal epidural metastases: a retrospective study. Spinal cord 58(8): 892–899 [PubMed: 32047252] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Dardic, M, Wibmer, Christine, Berghold, A et al. (2015) Evaluation of prognostic scoring systems for spinal metastases in 196 patients treated during 2005-2010. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 24(10): 2133–41 [PubMed: 25082760] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| De la Garza Ramos, R., Goodwin, C.R., Jain, A. et al. (2016) Development of a Metastatic Spinal Tumor Frailty Index (MSTFI) Using a Nationwide Database and Its Association with Inpatient Morbidity, Mortality, and Length of Stay After Spine Surgery. World Neurosurgery 95: 548–555 [PubMed: 27544340] | Outcomes do not match protocol – predicts peri operative outcomes |
| De la Garza Ramos, Rafael, Benton, Joshua A, Gelfand, Yaroslav et al. (2021) A Novel Clinical Scoring System for Perioperative Morbidity in Metastatic Spinal Tumor Surgery: The Spine Oncology Morbidity Assessment Score. Spine 46(3): e161–e166 [PubMed: 33038202] | Outcomes do not match protocol - predicts post operative morbidity |
| De la Garza Ramos, Rafael, Naidu, Ishan, Choi, Jong Hyun et al. (2021) Comparison of three predictive scoring systems for morbidity in oncological spine surgery. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 94: 13–17 [PubMed: 34863427] | Outcomes do not match protocol – surgical morbidity |
| Derincek, Alihan, Guler, Umit O, Uysal, Mustafa et al. (2020) Spinal Metastatic Disease: Survival Analysis of 146 Patients and Evaluation of 4 Different Preoperative Scoring Systems. Clinical spine surgery 33(2): e81–e86 [PubMed: 31393277] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Donnellan, Christopher J, Roser, Sophia, Maharaj, Monish M et al. (2020) Outcomes for Vertebrectomy for Malignancy and Correlation to the Spine Instability Neoplastic Score (SINS): a 10-Year Single-Center Perspective. World neurosurgery 138: e151–e159 [PubMed: 32081818] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Douglas, S; Schild, S E; Rades, D (2012) Metastatic spinal cord compression in patients with cancer of unknown primary. Estimating the survival prognosis with a validated score. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft … [et al] 188(11): 1048–51 [PubMed: 23053138] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Douglas, Sarah; Schild, Steven E; Rades, Dirk (2012) A new score predicting the survival of patients with spinal cord compression from myeloma. BMC cancer 12: 425 [PMC free article: PMC3517459] [PubMed: 23009630] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Ehresman, J., Schilling, A., Pennington, Z. et al. (2020) A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis. Journal of Neurosurgery: Spine 32(4): 499–506 [PubMed: 31860825] | Other protocol criteria - not a validated scoring system |
| Ehresman, Jeff, Lubelski, Daniel, Pennington, Zach et al. (2021) Utility of prediction model score: a proposed tool to standardize the performance and generalizability of clinical predictive models based on systematic review. Journal of neurosurgery. Spine: 1–9 [PubMed: 33636704] | Other protocol criteria - not a validated scoring system |
| Enkaoua, E A, Doursounian, L, Chatellier, G et al. (1997) Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases. Spine 22(19): 2293–8 [PubMed: 9346151] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Feng, Jiang-Tao, Yang, Xiong-Gang, Wang, Feng et al. (2019) Prognostic Discrepancy on Overall Survival Between Ambulatory and Nonambulatory Patients with Metastatic Spinal Cord Compression. World neurosurgery 121: e322–e332 [PubMed: 30261374] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Finnigan, Renee, Burmeister, Bryan, Barry, Tamara et al. (2015) Technique and early clinical outcomes for spinal and paraspinal tumours treated with stereotactic body radiotherapy. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 22(8): 1258–63 [PubMed: 25979254] | Outcomes do not match protocol – predictive factors/association between SINS and incidence of VCFs |
| Fisher, CG, DiPaola, CP, Ryken, TC et al. (2010) A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine 35(22): E1221–9 [PubMed: 20562730] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Fisher, Charles G, Schouten, Rowan, Versteeg, Anne L et al. (2014) Reliability of the Spinal Instability Neoplastic Score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases. Radiation oncology (London, England) 9: 69 [PMC free article: PMC3995991] [PubMed: 24594004] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Foerster, Robert, Habermehl, Daniel, Bruckner, Thomas et al. (2014) Spinal bone metastases in gynecologic malignancies: a retrospective analysis of stability, prognostic factors and survival. Radiation oncology (London, England) 9: 194 [PMC free article: PMC4163163] [PubMed: 25182126] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system – study of prognostic factors |
| Fox, S., Spiess, M., Hnenny, L. et al. (2017) Spinal Instability Neoplastic Score (SINS): Reliability Among Spine Fellows and Resident Physicians in Orthopedic Surgery and Neurosurgery. Global Spine Journal 7(8): 744–748 [PMC free article: PMC5721994] [PubMed: 29238637] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - evaluates spinal surgery trainees use of tool (inter and intra observer reliability) |
| Gallizia, E, Apicella, G, Cena, T et al. (2017) The spine instability neoplastic score (SINS) in the assessment of response to radiotherapy for bone metastases. Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 19(11): 1382–1387 [PubMed: 28623513] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Gao, Qing-Peng, Yang, Da-Zhi, Yuan, Zheng-Bin et al. (2021) Prognostic factors and its predictive value in patients with metastatic spinal cancer. World journal of clinical cases 9(20): 5470–5478 [PMC free article: PMC8281408] [PubMed: 34307601] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Gao, Zhong-Yu, Zhang, Tao, Zhang, Hui et al. (2021) Establishment and validation of nomogram model for survival predicting in patients with spinal metastases secondary to lung cancer. Neurological research 43(4): 327–335 [PubMed: 33377432] | Other protocol criteria - not a validated scoring system |
| Ghori, Ahmer K, Leonard, Dana A, Schoenfeld, Andrew J et al. (2015) Modeling 1-year survival after surgery on the metastatic spine. The spine journal : official journal of the North American Spine Society 15(11): 2345–50 [PubMed: 26160329] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Gjyshi, Olsi, Boyce-Fappiano, David, Pezzi, Todd A et al. (2020) Spine stereotactic radiosurgery for metastases from hepatobiliary malignancies: patient selection using PRISM scoring. Journal of neuro-oncology 148(2): 327–334 [PubMed: 32358642] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Goodwin, C Rory, Schoenfeld, Andrew J, Abu-Bonsrah, Nancy A et al. (2016) Reliability of a spinal metastasis prognostic score to model 1-year survival. The spine journal : official journal of the North American Spine Society 16(9): 1102–8 [PubMed: 27080411] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Hacking, H.G.A.; Van As, H.H.J.; Lankhorst, G.J. (1993) Factors related to the outcome of inpatient rehabilitation in patients with neoplastic epidural spinal cord compression. Paraplegia 31(6): 367–374 [PubMed: 8336999] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Han, Shuai, Wang, Ting, Jiang, Dongjie et al. (2015) Surgery and survival outcomes of 30 patients with neurological deficit due to clear cell renal cell carcinomaspinal metastases. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 24(8): 1786–91 [PubMed: 25840782] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system – evaluates scores on scales as prognostic factors |
| Hardisty, Michael, Wright, Trinette, Campbell, Mikki et al. (2020) CT based quantitative measures of the stability of fractured metastatically involved vertebrae treated with spine stereotactic body radiotherapy. Clinical & experimental metastasis 37(5): 575–584 [PubMed: 32643007] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| He, Xin, Jiao, Yong-Qiang, Yang, Xiong-Gang et al. (2020) A Novel Prediction Tool for Overall Survival of Patients Living with Spinal Metastatic Disease. World neurosurgery 144: e824–e836 [PubMed: 32956891] | Other protocol criteria - not a validated scoring system |
| Hernandez-Fernandez, Alberto, Velez, Roberto, Lersundi-Artamendi, Ana et al. (2012) External validity of the Tokuhashi score in patients with vertebral metastasis. Journal of cancer research and clinical oncology 138(9): 1493–500 [PubMed: 22526160] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Hersh, Andrew M, Pennington, Zach, Hung, Bethany et al. (2021) Comparison of frailty metrics and the Charlson Comorbidity Index for predicting adverse outcomes in patients undergoing surgery for spine metastases. Journal of neurosurgery. Spine: 1–9 [PubMed: 34826820] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Hessler, Christian, Vettorazzi, Eik, Madert, Juergen et al. (2011) Actual and predicted survival time of patients with spinal metastases of lung cancer: evaluation of the robustness of the Tokuhashi score. Spine 36(12): 983–9 [PubMed: 21217434] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Hu, Ming-Hsiao, Yen, Hung-Kuan, Chen, I-Hsin et al. (2022) Decreased psoas muscle area is a prognosticator for 90-day and 1-year survival in patients undergoing surgical treatment for spinal metastasis. Clinical nutrition (Edinburgh, Scotland) 41(3): 620–629 [PubMed: 35124469] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system – evaluates impact of adding an individual prognostic factor to a range of prognostic tools |
| Hutton, Jonathon and Leung, John (2013) Treatment of spinal cord compression: are we overusing radiotherapy alone compared to surgery and radiotherapy?. Asia-Pacific journal of clinical oncology 9(2): 123–8 [PubMed: 23046299] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system – prediction of treatment outcome |
| Jensen, Garrett, Tang, Chad, Hess, Kenneth R et al. (2017) Internal validation of the prognostic index for spine metastasis (PRISM) for stratifying survival in patients treated with spinal stereotactic radio-surgery. Journal of radiosurgery and SBRT 5(1): 25–34 [PMC free article: PMC5675505] [PubMed: 29296460] | Other protocol criteria - not a validated scoring system |
| Kanda, Yutaro, Kakutani, Kenichiro, Sakai, Yoshitada et al. (2021) Surgical outcomes and risk factors for poor outcomes in patients with cervical spine metastasis: a prospective study. Journal of orthopaedic surgery and research 16(1): 423 [PMC free article: PMC8254288] [PubMed: 34217343] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Karhade, A.V., Thio, Q.C.B.S., Ogink, P.T. et al. (2019) Development of Machine Learning Algorithms for Prediction of 30-Day Mortality after Surgery for Spinal Metastasis. Clinical Neurosurgery 85(1): e83–e91 [PubMed: 30476188] | Other protocol criteria - not a validated scoring system |
| Karhade, Aditya V, Ahmed, Ali K, Pennington, Zach et al. (2020) External validation of the SORG 90-day and 1-year machine learning algorithms for survival in spinal metastatic disease. Spine Journal, 20(1): 14–21 [PubMed: 31505303] | Other protocol criteria - not a validated scoring system |
| Karhade, Aditya V, Thio, Quirina C B S, Ogink, Paul T et al. (2019) Predicting 90-Day and 1-Year Mortality in Spinal Metastatic Disease: Development and Internal Validation. Neurosurgery 85(4): e671–e681 [PubMed: 30869143] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - compares performance of modelling techniques |
| Katagiri, H, Takahashi, M, Wakai, K et al. (2005) Prognostic factors and a scoring system for patients with skeletal metastasis. The Journal of bone and joint surgery. British volume 87(5): 698–703 [PubMed: 15855375] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Kato, Satoshi, Murakami, Hideki, Demura, Satoru et al. (2019) Kidney and Thyroid Cancer-Specific Treatment Algorithm for Spinal Metastases: A Validation Study. World neurosurgery 122: e1305–e1311 [PubMed: 30448587] | Other protocol criteria - not a validated scoring system |
| Kerstens, Peter; Yi, Ma; James, Melissa (2019) Radiotherapy for metastatic spinal cord compression; can the Rades score predict survival?. Asia-Pacific journal of clinical oncology 15(6): 331–336 [PubMed: 31436904] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Kim, Young Rak, Lee, Chang-Hyun, Yang, Seung Heon et al. (2021) Accuracy and precision of the spinal instability neoplastic score (SINS) for predicting vertebral compression fractures after radiotherapy in spinal metastases: a meta-analysis. Scientific reports 11(1): 5553 [PMC free article: PMC7947012] [PubMed: 33692442] | Other protocol criteria - not a validated scoring system |
| Kim, Junhyung, Lee, Sun-Ho, Park, Se-Jun et al. (2014) Analysis of the predictive role and new proposal for surgical strategies based on the modified Tomita and Tokuhashi scoring systems for spinal metastasis. World journal of surgical oncology 12: 245 [PMC free article: PMC4124481] [PubMed: 25085251] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Kim, H., Chang, S.Y., Son, J. et al. (2021) The effect of adding biological factors to the decision-making process for spinal metastasis of non-small cell lung cancer. Journal of Clinical Medicine 10(5): 1–10 [PMC free article: PMC7962196] [PubMed: 33800124] | Other protocol criteria - not a validated scoring system - adds additional factors to an existing tool. |
| Kobayashi, Kazuyoshi, Ando, Kei, Nakashima, Hiroaki et al. (2020) Prognostic Factors in the New Katagiri Scoring System After Palliative Surgery for Spinal Metastasis. Spine 45(13): e813–e819 [PubMed: 32044810] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Kowalchuk, R.O., Mullikin, T.C., Harmsen, W.S. et al. (2022) Development and Internal Validation of a Recursive Partitioning Analysis-Based Model Predictive of Pain Flare Incidence After Spine Stereotactic Body Radiation Therapy. Practical Radiation Oncology [PubMed: 35151922] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - predicts pain flare after stereotactic body radiation therapy |
| Kowalchuk, Roman O, Johnson-Tesch, Benjamin A, Marion, Joseph T et al. (2022) Development and Assessment of a Predictive Score for Vertebral Compression Fracture After Stereotactic Body Radiation Therapy for Spinal Metastases. JAMA oncology 8(3): 412–419 [PMC free article: PMC8796057] [PubMed: 35084429] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Kwan, Kenny Yat Hong, Lam, Tai Chung, Choi, Horace Cheuk Wai et al. (2018) Prediction of survival in patients with symptomatic spinal metastases: Comparison between the Tokuhashi score and expert oncologists. Surgical oncology 27(1): 7–10 [PubMed: 29549906] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Lakomkin, Nikita, Zuckerman, Scott L, Stannard, Blaine et al. (2019) Preoperative Risk Stratification in Spine Tumor Surgery: A Comparison of the Modified Charlson Index, Frailty Index, and ASA Score. Spine 44(13): e782–e787 [PubMed: 31205174] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Lee, Chang-Hyun, Chung, Chun Kee, Jahng, Tae-Ahn et al. (2015) Which one is a valuable surrogate for predicting survival between Tomita and Tokuhashi scores in patients with spinal metastases? A meta-analysis for diagnostic test accuracy and individual participant data analysis. Journal of neuro-oncology 123(2): 267–75 [PubMed: 25947287] | Study design - systematic review without pooled results/quantitative data, checked for relevant studies |
| Lee, Chang-Hyun, Hong, Jae Taek, Lee, Sun-Ho et al. (2021) Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis. Journal of Korean Neurosurgical Society 64(1): 4–12 [PMC free article: PMC7819788] [PubMed: 32580266] | Study design - systematic review without pooled results/quantitative data, checked for relevant studies |
| Lee, Sun-Ho, Tatsui, Claudio E, Ghia, Amol J et al. (2016) Can the spinal instability neoplastic score prior to spinal radiosurgery predict compression fractures following stereotactic spinal radiosurgery for metastatic spinal tumor?: a post hoc analysis of prospective phase II single-institution trials. Journal of neuro-oncology 126(3): 509–17 [PubMed: 26643804] | Other protocol criteria - overlap with study population of Sahgal 2013 - which is reported in an included systematic review (Kim 2021) |
| Lei, M., Liu, S., Yang, S. et al. (2016) Validation of a model with which to predict the survival prognosis of patients with spinal cord compression resulted from metastatic cancers. European Journal of Surgical Oncology 42(12): 1924–1930 | Other protocol criteria - not a validated scoring system |
| Lei, Mingxing, Liu, Yaosheng, Tang, Chuanghao et al. (2015) Prediction of survival prognosis after surgery in patients with symptomatic metastatic spinal cord compression from non-small cell lung cancer. BMC cancer 15: 853 [PMC free article: PMC4635615] [PubMed: 26541141] | Other protocol criteria - not a validated scoring system |
| Lei, Mingxing, Liu, Yaosheng, Yan, Liang et al. (2016) A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 25(12): 3971–3978 [PubMed: 26507323] | Other protocol criteria - not a validated scoring system |
| Leithner, Andreas, Radl, Roman, Gruber, Gerald et al. (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 17(11): 1488–95 [PMC free article: PMC2583181] [PubMed: 18787846] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Li, Zemin, Long, Houqing, Guo, Rui et al. (2018) Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ). Journal of orthopaedic surgery and research 13(1): 20 [PMC free article: PMC5791728] [PubMed: 29382354] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Liu, Shuzhong, Zhou, Xi, Song, An et al. (2020) Clinical Characteristics and Prognostic Analysis of Gynecologic Cancer with Spinal Metastases: A Single-Center Retrospective Study. Cancer management and research 12: 7515–7525 [PMC free article: PMC7445528] [PubMed: 32903851] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Liu, Yujie, Li, Lin, Jiang, Dongjie et al. (2021) A Novel Nomogram for Survival Prediction of Patients with Spinal Metastasis From Prostate Cancer. Spine 46(6): e364–e373 [PubMed: 33620180] | Other protocol criteria - not a validated scoring system |
| Liu, Yujie, Yang, Minglei, Li, Bo et al. (2019) Development of a novel model for predicting survival of patients with spine metastasis from colorectal cancer. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 28(6): 1491–1501 [PubMed: 30659348] | Other protocol criteria - not a validated scoring system |
| Majeed, H, Kumar, S, Bommireddy, R et al. (2012) Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease. Annals of the Royal College of Surgeons of England 94(1): 28–33 [PMC free article: PMC3954183] [PubMed: 22524919] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - compares survival of patients who underwent surgery with their expected survival (calculated before surgery) |
| Massaad, E., Hadzipasic, M., Alvarez-Breckenridge, C. et al. (2020) Predicting tumor-specific survival in patients with spinal metastatic renal cell carcinoma: Which scoring system is most accurate?. Journal of Neurosurgery: Spine 33(4): 529–539 [PubMed: 32502990] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Masuda, Kenji, Ebata, Ko, Yasuhara, Yoshimasa et al. (2018) Out-comes and Prognosis of Neurological Decompression and Stabilization for Spinal Metastasis: Is Assessment with the Spinal Instability Neoplastic Score Useful for Predicting Surgical Results?. Asian spine journal 12(5): 846–853 [PMC free article: PMC6147881] [PubMed: 30213167] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Matsumiya, H., Todo, Y., Okamoto, K. et al. (2016) A prediction model of survival for patients with bone metastasis from uterine cervical cancer. Journal of Gynecologic Oncology 27(6): e55 [PMC free article: PMC5078818] [PubMed: 27550401] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Mezei, Tamas, Horvath, Anna, Pollner, Peter et al. (2020) Research on the predicting power of the revised Tokuhashi system: how much time can surgery give to patients with short life expectancy?. International journal of clinical oncology 25(4): 755–764 [PMC free article: PMC7118051] [PubMed: 31993865] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Mikula, Anthony L, Pennington, Zach, Lakomkin, Nikita et al. (2022) Independent predictors of vertebral compression fracture following radiation for metastatic spine disease. Journal of neurosurgery. Spine: 1–7 [PubMed: 35426824] | Other protocol criteria - not available |
| Mizumoto, M., Harada, H., Asakura, H. et al. (2008) Prognostic factors and a scoring system for survival after radiotherapy for metastases to the spinal column: A review of 544 patients at Shizuoka Cancer Center Hospital. Cancer 113(10): 2816–2822 [PubMed: 18846565] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Mohd Rothi, Illina; Deverall, Hamish H; Baker, Joseph F (2019) The modified Frailty Index does not correlate with survival in surgicallytreated patients with metastatic spine disease. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 66: 178–181 [PubMed: 31101585] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Morgen, Soren Schmidt, Fruergaard, Sidsel, Gehrchen, Martin et al. (2018) A revision of the Tokuhashi revised score improves the prognostic ability in patients with metastatic spinal cord compression. Journal of cancer research and clinical oncology 144(1): 33–38 [PubMed: 28986702] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Morgen, Soren Schmidt, Nielsen, Dennis Hallager, Larsen, Claus Falck et al. (2014) Moderate precision of prognostic scoring systems in a consecutive, prospective cohort of 544 patients with metastatic spinal cord compression. Journal of cancer research and clinical oncology 140(12): 2059–64 [PubMed: 25035249] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Nater, Anick, Chuang, Junior, Liu, Kuan et al. (2020) A Personalized Medicine Approach for the Management of Spinal Metastases with Cord Compression: Development of a Novel Clinical Prediction Model for Postoperative Survival and Quality of Life. World neurosurgery 140: 654–663e13 [PubMed: 32797992] | Other protocol criteria - not a validated scoring system |
| Nater, Anick, Tetreault, Lindsay A, Kopjar, Branko et al. (2018) Predictive factors of survival in a surgical series of metastatic epidural spinal cord compression and complete external validation of 8 multivariate models of survival in a prospective North American multicenter study. Cancer 124(17): 3536–3550 [PubMed: 29975401] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Nenclares, P, Guardado, S, Asiain, L et al. (2020) A new and simple scoring system to predict overall survival after irradiation for metastatic spinal cord compression. Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico 22(3): 440–444 [PubMed: 31165978] | Other protocol criteria - not a validated scoring system |
| Ogihara, Satoshi, Seichi, Atsushi, Hozumi, Takahiro et al. (2006) Prognostic factors for patients with spinal metastases from lung cancer. Spine 31(14): 1585–90 [PubMed: 16778693] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Oh, I.-S.; Kim, S.-I.; Ha, K.-Y. (2011) Significant predictive values for the life expectancy in patients with spinal metastasis following surgical treatment. European Journal of Orthopaedic Surgery and Traumatology: 1–8 | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Osong, B., Sanli, I., Willems, P.C. et al. (2021) Overall survival nomogram for patients with spinal bone metastases (SBM). Clinical and Translational Radiation Oncology 28: 48–53 [PMC free article: PMC7985219] [PubMed: 33778172] | Other protocol criteria - not a validated scoring system |
| Pahuta, Markian A, Werier, Joel, Wai, Eugene K et al. (2019) Back to Bayesian: A strategy to enhance prognostication of metastatic spine disease. International journal of clinical practice 73(4): e13322 [PubMed: 30843333] | Study design does not match review protocol |
| Papastefanou, Sotiris, Alpantaki, Kalliopi, Akra, Gabriel et al. (2012) Predictive value of Tokuhashi and Tomita scores in patients with metastatic spine disease. Acta orthopaedica et traumatologica turcica 46(1): 50–6 [PubMed: 22441452] | Study design does not match review protocol |
| Park, Hae Jin, Kim, Hee Jung, Won, Jong-Ho et al. (2015) Stereotactic Body Radiotherapy (SBRT) for Spinal Metastases: Who Will Benefit the Most from SBRT?. Technology in cancer research & treatment 14(2): 159–67 [PubMed: 24502552] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factors study |
| Park, SeJun, Lee, ChongSuh, Chung, SungSoo et al. (2015) How accurately can tokuhashi score system predict survival in the current practice for spinal metastases?: prospective analysis of 145 consecutive patients between 2007 and 2013. Journal of spinal disorders & techniques 28(4): e219–24 [PubMed: 25393667] | Other protocol criteria - duplicate publication |
| Paulino Pereira, Nuno Rui, Janssen, Stein J, van Dijk, Eva et al. (2016) Development of a Prognostic Survival Algorithm for Patients with Metastatic Spine Disease. The Journal of bone and joint surgery. American volume 98(21): 1767–1776 [PubMed: 27807108] | Other protocol criteria - not a validated scoring system |
| Paulino Pereira, Nuno Rui, Mclaughlin, Lily, Janssen, Stein J et al. (2017) The SORG nomogram accurately predicts 3- and 12-months survival for operable spine metastatic disease: External validation. Journal of surgical oncology 115(8): 1019–1027 [PubMed: 28346699] | Other protocol criteria - not a validated scoring system |
| Pennington, Zach, Ahmed, A Karim, Westbroek, Erick M et al. (2019) SINS Score and Stability: Evaluating the Need for Stabilization Within the Uncertain Category. World neurosurgery 128: e1034–e1047 [PubMed: 31103761] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Phinyo, Phichayut, Boonyanaruthee, Chonmavadh, Paholpak, Permsak et al. (2020) Natural disease progression and novel survival prediction model for hepatocellular carcinoma with spinal metastases: a 10-year single-center study. World journal of surgical oncology 18(1): 135 [PMC free article: PMC7306143] [PubMed: 32563268] | Other protocol criteria - not a validated scoring system |
| Pollner, Peter, Horvath, Anna, Mezei, Tamas et al. (2018) Analysis of Four Scoring Systems for the Prognosis of Patients with Metastasis of the Vertebral Column. World neurosurgery 112: e675–e682 [PubMed: 29409889] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Quraishi, Nasir A, Arealis, George, Salem, Khalid M I et al. (2015) The surgical management of metastatic spinal tumors based on an Epidural Spinal Cord Compression (ESCC) scale. The spine journal : official journal of the North American Spine Society 15(8): 1738–43 [PubMed: 25817737] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Bartscht, T., Janssen, S. et al. (2016) Forecasting survival probabilities after radiotherapy of metastatic epidural spinal cord compression from colorectal cancer in the elderly. Anticancer Research 36(4): 1829–1833 [PubMed: 27069166] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Douglas, S., Veninga, T. et al. (2012) A survival score for patients with metastatic spinal cord compression from prostate cancer. Strahlentherapie und Onkologie 188(9): 802–806 [PubMed: 22526228] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Douglas, S., Veninga, T. et al. (2010) Validation and simplification of a score predicting survival in patients irradiated for metastatic spinal cord compression. Cancer 116(15): 3670–3673 [PubMed: 20564129] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Evers, J.N., Bajrovic, A. et al. (2014) Metastatic spinal cord compression: A validated survival score for elderly patients. Strahlentherapie und Onkologie 190(10): 919–924 [PubMed: 24658606] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Evers, J.N., Rudat, V. et al. (2014) A validated score estimating ambulatory status following radiotherapy of elderly patients for metastatic spinal cord compression. BMC Cancer 14(1): 589 [PMC free article: PMC4139608] [PubMed: 25123656] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D.; Hueppe, M.; Schild, S.E. (2013) A score to identify patients with metastatic spinal cord compression who may be candidates for best supportive care. Cancer 119(4): 897–903 [PubMed: 23065671] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Huttenlocher, S., Bajrovic, A. et al. (2015) A new instrument for estimating the survival of patients with metastatic epidural spinal cord compression from esophageal cancer. Radiology and Oncology 49(1): 86–90 [PMC free article: PMC4362612] [PubMed: 25810707] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D., Veninga, T., Bajrovic, A. et al. (2013) A validated scoring system to identify long-term survivors after radiotherapy for metastatic spinal cord compression. Strahlentherapie und Onkologie 189(6): 462–466 [PubMed: 23604188] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D, Douglas, S, Huttenlocher, S et al. (2012) Prognostic factors and a survival score for patients with metastatic spinal cord compression from colorectal cancer. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft … [et al] 188(12): 1114–8 [PubMed: 23111468] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, D; Douglas, S; Schild, S E (2013) A validated survival score for breast cancer patients with metastatic spinal cord compression. Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft … [et al] 189(1): 41–6 [PubMed: 23138773] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk; Bajrovic, Amira; Bartscht, Tobias (2017) Predictive Factors and a Survival Score for Patients Irradiated for Metastatic Spinal Cord Compression from Carcinoma of the Salivary Glands. Anticancer research 37(12): 7011–7015 [PubMed: 29187488] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Cacicedo, Jon, Lomidze, Darejan et al. (2022) A New and Easy-to-Use Survival Score for Patients Irradiated for Metastatic Epidural Spinal Cord Compression. Practical radiation oncology [PubMed: 35395423] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde, Antonio J, Garcia, Raquel et al. (2015) A new instrument for estimation of survival in elderly patients irradiated for metastatic spinal cord compression from breast cancer. Radiation oncology (London, England) 10: 173 [PMC free article: PMC4554297] [PubMed: 26282125] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde-Moreno, Antonio J, Cacicedo, Jon et al. (2015) Metastatic Spinal Cord Compression: A Survival Score Particularly Developed for Elderly Prostate Cancer Patients. Anticancer research 35(11): 6189–92 [PubMed: 26504049] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde-Moreno, Antonio J, Cacicedo, Jon et al. (2016) Estimating the Survival of Elderly Patients with Renal Cell Carcinoma Presenting with Malignant Spinal Cord Compression. Anticancer research 36(1): 409–13 [PubMed: 26722074] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde-Moreno, Antonio J, Cacicedo, Jon et al. (2018) A scoring system to predict local progression-free survival in patients irradiated with 20 Gy in 5 fractions for malignant spinal cord compression. Radiation oncology (London, England) 13(1): 257 [PMC free article: PMC6311053] [PubMed: 30594231] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde-Moreno, Antonio J, Garcia, Raquel et al. (2015) A Tool to Estimate Survival of Elderly Patients Presenting with Metastatic Epidural Spinal Cord Compression (MESCC) from Cancer of Unknown Primary. Anticancer research 35(11): 6219–22 [PubMed: 26504054] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde-Moreno, Antonio J, Segedin, Barbara et al. (2016) A Prognostic Instrument to Estimate the Survival of Elderly Patients Irradiated for Metastatic Epidural Spinal Cord Compression From Lung Cancer. Clinical lung cancer 17(4): 279–84 [PubMed: 26597378] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Conde-Moreno, Antonio Jose, Cacicedo, Jon et al. (2016) A predictive tool particularly designed for elderly myeloma patients presenting with spinal cord compression. BMC cancer 16: 292 [PMC free article: PMC4845505] [PubMed: 27112210] | Other protocol criteria - not a validated scoring system |
| Rades, Dirk, Douglas, Sarah, Huttenlocher, Stefan et al. (2011) Validation of a score predicting post-treatment ambulatory status after radiotherapy for metastatic spinal cord compression. International journal of radiation oncology, biology, physics 79(5): 1503–6 [PubMed: 20605351] | Other protocol criteria - not a validated scoring system |
| Rades, Dirk, Douglas, Sarah, Veninga, Theo et al. (2012) A validated survival score for patients with metastatic spinal cord compression from non-small cell lung cancer. BMC cancer 12: 302 [PMC free article: PMC3411487] [PubMed: 22817686] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk; Dunst, Juergen; Schild, Steven E (2008) The first score predicting overall survival in patients with metastatic spinal cord compression. Cancer 112(1): 157–61 [PubMed: 17948910] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Rades, Dirk, Haus, Rapha, Schild, Steven E et al. (2019) Prognostic factors and a new scoring system for survival of patients irradiated for bone metastases. BMC cancer 19(1): 1156 [PMC free article: PMC6883567] [PubMed: 31779595] | Other protocol criteria - not a validated scoring system |
| Rades, Dirk, Huttenlocher, Stefan, Bartscht, Tobias et al. (2015) Predicting the survival probability of gastric cancer patients developing metastatic epidural spinal cord compression (MESCC). Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 18(4): 881–4 [PubMed: 25588752] | Other protocol criteria - not a validated scoring system |
| Rades, Dirk, Motisi, Laura, Veninga, Theo et al. (2019) Predictors of Outcomes and a Scoring System for Estimating Survival in Patients Treated With Radiotherapy for Metastatic Spinal Cord Compression From Small-Cell Lung Cancer. Clinical lung cancer 20(4): 322–329 [PubMed: 31155476] | Other protocol criteria - not a validated scoring system |
| Rades, Dirk, Schild, Steven E, Karstens, Johann H et al. (2015) Predicting survival of patients with metastatic epidural spinal cord compression from cancer of the head-and-neck. Anticancer research 35(1): 385–8 [PubMed: 25550576] | Other protocol criteria - not a validated scoring system |
| Ragel, Brian T, Mendez, Gustavo A, Reddington, Justin et al. (2017) Life Expectancy and Metastatic Spine Scoring Systems: An Academic Institutional Experience. Clinical spine surgery 30(8): 335–342 [PubMed: 28937454] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Sanli, I, Osong, B, Dekker, A et al. (2022) Radiomics biopsy signature for predicting survival in patients with spinal bone metastases (SBMs). Clinical and translational radiation oncology 33: 57–65 [PMC free article: PMC8777154] [PubMed: 35079642] | Other protocol criteria - not a validated scoring system |
| Schoenfeld, A.J., Le, H.V., Marjoua, Y. et al. (2016) Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS). Spine Journal 16(4): 482–490 [PubMed: 26409416] | Other protocol criteria - not a validated scoring system |
| Schoenfeld, Andrew J, Blucher, Justin A, Barton, Lauren B et al. (2020) Design of the prospective observational study of spinal metastasis treatment (POST). The spine journal : official journal of the North American Spine Society 20(4): 572–579 [PubMed: 31712164] | Other protocol criteria - not a validated scoring system |
| Schoenfeld, Andrew J, Ferrone, Marco L, Blucher, Justin A et al. (2022) Prospective comparison of the accuracy of the New England Spinal Metastasis Score (NESMS) to legacy scoring systems in prognosticating outcomes following treatment of spinal metastases. The spine journal : official journal of the North American Spine Society 22(1): 39–48 [PMC free article: PMC8443703] [PubMed: 33741509] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Schoenfeld, Andrew J, Ferrone, Marco L, Schwab, Joseph H et al. (2021) Prospective validation of a clinical prediction score for survival in patients with spinal metastases: the New England Spinal Metastasis Score. The spine journal : official journal of the North American Spine Society 21(1): 28–36 [PubMed: 32087387] | Other protocol criteria - not a validated scoring system |
| Shah, Akash A, Karhade, Aditya V, Park, Howard Y et al. (2021) Updated external validation of the SORG machine learning algorithms for prediction of ninety-day and one-year mortality after surgery for spinal metastasis. The spine journal : official journal of the North American Spine Society 21(10): 1679–1686 [PubMed: 33798728] | Other protocol criteria - not a validated scoring system |
| Shi, Diana D, Chen, Yu-Hui, Lam, Tai Chung et al. (2018) Assessing the utility of a prognostication model to predict 1-year mortality in patients undergoing radiation therapy for spinal metastases. The spine journal : official journal of the North American Spine Society 18(6): 935–940 [PubMed: 29031992] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Shi, Diana D, Hertan, Lauren M, Lam, Tai Chung et al. (2018) Assessing the utility of the spinalinstability neoplastic score (SINS) topredict fracture after conventional radiation therapy (RT) for spinal metastases. Practical radiation oncology 8(5): e285–e294 [PubMed: 29703703] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Smeijers, S and Depreitere, B (2021) Prognostic scores for survival as decisional support for surgery in spinal metastases: a performance assessment systematic review. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 30(10): 2800–2824 [PubMed: 34398337] | Study design - systematic review without pooled results/quantitative data, checked for relevant studies |
| Sutcliffe, P, Connock, M, Shyangdan, D et al. (2013) A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression. Health technology assessment (Winchester, England) 17(42): 1–274 [PMC free article: PMC4781430] [PubMed: 24070110] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Szoverfi, Zsolt, Lazary, Aron, Bozsodi, Arpad et al. (2014) Primary Spinal Tumor Mortality Score (PSTMS): a novel scoring system for predicting poor survival. The spine journal : official journal of the North American Spine Society 14(11): 2691–700 [PubMed: 24650850] | Other protocol criteria - not a validated scoring system |
| Tan, Jonathan, Tan, Kimberly Anne, Zaw, Aye Sandar et al. (2017) 43 - Evaluation of prognostic factors and a modification to the modified tokuhashi score in patients with spinal metastases from breast cancer. Spine Journal 17: 16–s16 [PubMed: 28749856] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Tang, Chad, Hess, Kenneth, Bishop, Andrew J et al. (2015) Creation of a Prognostic Index for Spine Metastasis to Stratify Survival in Patients Treated With Spinal Stereotactic Radiosurgery: Secondary Analysis of Mature Prospective Trials. International journal of radiation oncology, biology, physics 93(1): 118–25 [PubMed: 26130231] | Other protocol criteria - not a validated scoring system |
| Tokuhashi, Y., Matsuzaki, H., Toriyama, S. et al. (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15(11): 1110–1113 [PubMed: 1702559] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Tokuhashi, Y, Matsuzaki, H, Kawano, H et al. (1994) [The indication of operative procedure for a metastatic spine tumor: a scoring system for the preoperative evaluation of the prognosis]. Nihon Seikeigeka Gakkai zasshi 68(5): 379–89 [PubMed: 8051465] | Other protocol criteria – not available in English |
| Tokuhashi, Yasuaki, Matsuzaki, Hiromi, Oda, Hiroshi et al. (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30(19): 2186–91 [PubMed: 16205345] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - describes development of the revised Tokuhashi Scoring System - no external validation reported |
| Tokuhashi, Yasuaki; Uei, Hiroshi; Oshima, Masashi (2017) Classification and scoring systems for metastatic spine tumors: a literature review. Spine surgery and related research 1(2): 44–55 [PMC free article: PMC6698555] [PubMed: 31440612] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Tokuhashi, Yasuaki, Uei, Hiroshi, Oshima, Masashi et al. (2014) Scoring system for prediction of metastatic spine tumor prognosis. World journal of orthopedics 5(3): 262–71 [PMC free article: PMC4095019] [PubMed: 25035829] | Study design - systematic review without pooled results/quantitative data, checked for relevant studies |
| Uei, Hiroshi and Tokuhashi, Yasuaki (2018) Prognostic factors in patients with metastatic spine tumors derived from lung cancer-a novel scoring system for predicting life expectancy. World journal of surgical oncology 16(1): 131 [PMC free article: PMC6034326] [PubMed: 29976208] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Uei, Hiroshi and Tokuhashi, Yasuaki (2020) Prognostic scoring system for metastatic spine tumors derived from hepatocellular carcinoma. Journal of orthopaedic surgery (Hong Kong) 28(1): 2309499019899167 [PubMed: 32114893] | Other protocol criteria - not a validated scoring system |
| Ulmar, Benjamin, Naumann, Ulrike, Catalkaya, Sibel et al. (2007) Prognosis scores of Tokuhashi and Tomita for patients with spinal metastases of renal cancer. Annals of surgical oncology 14(2): 998–1004 [PubMed: 17083006] |
- Exclude Patients included in Ulmar 2007 |
| Ulmar, Benjamin, Reichel, Heiko, Catalkaya, Sibel et al. (2007) Evaluation and modification of the Tomita score in 217 patients with vertebral metastases. Onkologie 30(89): 414–8 [PubMed: 17848812] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Ulmar, Benjamin, Richter, Marcus, Cakir, Balkan et al. (2005) The Tokuhashi score: significant predictive value for the life expectancy of patients with breast cancer with spinal metastases. Spine 30(19): 2222–6 [PubMed: 16205351] |
- Exclude Patients included in Ulmar 2007 |
| van der Linden, Yvette M, Dijkstra, Sander P D S, Vonk, Ernest J A et al. (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103(2): 320–8 [PubMed: 15593360] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Vanek, Petr, Bradac, Ondrej, Trebicky, Ferdinand et al. (2015) Influence of the Preoperative Neurological Status on Survival After the Surgical Treatment of Symptomatic Spinal Metastases With Spinal Cord Compression. Spine 40(23): 1824–30 [PubMed: 26536440] | Other protocol criteria - not a validated scoring system |
| Verlaan, J.-J., Choi, D., Versteeg, A. et al. (2016) Characteristics of patients who survived <, 3 months or >2 years after surgery for spinal metastases: Can we avoid inappropriate patient selection?. Journal of Clinical Oncology 34(25): 3054–3061 [PMC free article: PMC6366641] [PubMed: 27400936] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Veronesi, Francesca, Borsari, Veronica, Martini, Lucia et al. (2021) The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies. Aging and disease 12(2): 625–645 [PMC free article: PMC7990375] [PubMed: 33815887] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Versteeg, Anne L, Verlaan, Jorrit-Jan, Sahgal, Arjun et al. (2016) The Spinal Instability Neoplastic Score: Impact on Oncologic Decision Making. Spine 41 suppl 20: 231–s237 [PubMed: 27488297] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Walker, Allison, Bassale, Solange, Shukla, Rakendu et al. (2022) A Prognostic Index for Predicting Survival of Patients Undergoing Radiation Therapy for Spine Metastasis Using Recursive Partitioning Analysis. Journal of palliative medicine 25(1): 21–27 [PubMed: 34382867] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Wang, S., Liu, Q., Lei, M. et al. (2018) Validation of a scoring system predicting survival and function outcome in patients with metastatic epidural spinal cord compression (MESCC): A prospective and multicenter study. International Journal of Clinical and Experimental Medicine 11(3): 2465–2470 | Other protocol criteria - not a validated scoring system |
| Wanman, Johan, Jernberg, Johannes, Gustafsson, Patrik et al. (2021) Predictive Value of the Spinal Instability Neoplastic Score for Survival and Ambulatory Function After Surgery for Metastatic Spinal Cord Compression in 110 Patients with Prostate Cancer. Spine 46(8): 550–558 [PubMed: 33273445] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Wei, Daniel, Nistal, Dominic A, Sobotka, Stanislaw et al. (2019) New Predictive Index for Survival in Symptomatic Spinal Metastases. World neurosurgery 123: e133–e140 [PubMed: 30468921] | Other protocol criteria - not a validated scoring system |
| Whitehouse, S, Stephenson, J, Sinclair, V et al. (2016) A validation of the Oswestry Spinal Risk Index. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 25(1): 247–251 [PubMed: 25391625] | Other protocol criteria - not a validated scoring system |
| Wibmer, Christine, Leithner, Andreas, Hofmann, Gunter et al. (2011) Survival analysis of 254 patients after manifestation of spinal metastases: evaluation of seven preoperative scoring systems. Spine 36(23): 1977–86 [PubMed: 21304424] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Xing, D., Dong, Z., Zheng, X. et al. (2019) The protective effects of surgery according to the spinal instability neoplastic score for patients with the EGFR mutation, lung adenocarcinoma, and spinal metastatic instability. International Journal of Clinical and Experimental Medicine 12(11): 12764–12772 | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Yamashita, Takayuki, Aota, Yoichi, Kushida, Kazuyoshi et al. (2008) Changes in physical function after palliative surgery for metastatic spinal tumor: association of the revised Tokuhashi score with neurologic recovery. Spine 33(21): 2341–6 [PubMed: 18827700] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Yang, Minglei, Ma, Xiaoyu, Wang, Pengru et al. (2022) Prediction of Survival Prognosis for Spinal Metastasis From Cancer of Unknown Primary: Derivation and Validation of a Nomogram Model. Global spine journal: 21925682221103833 [PMC free article: PMC10676151] [PubMed: 35615968] | Other protocol criteria - not a validated scoring system |
| Yang, Minglei, Xu, Wei, Liu, Tielong et al. (2019) Development and Validation of a Novel Survival Prediction Model in Patients With Spinal Metastasis From Non-small Cell Lung Cancer. Spine 44(4): 246–257 [PubMed: 30059487] | Other protocol criteria - not a validated scoring system |
| Yang, Xiong-Gang, Feng, Jiang-Tao, Wang, Feng et al. (2019) Development and validation of a prognostic nomogram for the overall survival of patients living with spinal metastases. Journal of neurooncology 145(1): 167–176 [PubMed: 31549282] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Yang, Xiong-Gang, Wang, Feng, Feng, Jiang-Tao et al. (2019) Recursive Partitioning Analysis (RPA) of Prognostic Factors for Overall Survival in Patients with Spinal Metastasis: A New System for Stratified Treatment. World neurosurgery 127: e124–e131 [PubMed: 30862584] | Other protocol criteria - not a validated scoring system |
| Yilmazlar, Selcuk, Dogan, Seref, Caner, Basak et al. (2008) Comparison of prognostic scores and surgical approaches to treat spinal metastatic tumors: a review of 57 cases. Journal of orthopaedic surgery and research 3: 37 [PMC free article: PMC2553066] [PubMed: 18755019] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system |
| Zakaria, Hesham Mostafa, Wilkinson, Brandon Michael, Pennington, Zach et al. (2020) Sarcopenia as a Prognostic Factor for 90-Day and Overall Mortality in Patients Undergoing Spine Surgery for Metastatic Tumors: A Multicenter Retrospective Cohort Study. Neurosurgery 87(5): 1025–1036 [PubMed: 32592483] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Zang, Shizhao, He, Qin, Bao, Qiyuan et al. (2019) Establishment and validation of a novel survival prediction scoring algorithm for patients with non-small-cell lung cancer spinal metastasis. International journal of clinical oncology 24(9): 1049–1060 [PubMed: 31028506] | Other protocol criteria - not a validated scoring system |
| Zeng, JC, Song, YM, Liu, H et al. (2007) [The predictive value of the Tokuhashi revised scoring system for the survival time of patients with spinal metastases]. Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition 38(3): 488–91 [PubMed: 17593839] | Other protocol criteria – not available in English |
| Zhang, Dan, Xu, Wei, Liu, Tielong et al. (2013) Surgery and prognostic factors of patients with epidural spinal cord compression caused by hepatocellular carcinoma metastases: retrospective study of 36 patients in a single center. Spine 38(17): e1090–5 [PubMed: 23632333] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Zhao, C., Wang, Y., Cai, X. et al. (2020) Prognostic significance of a novel score model based on preoperative indicators in patients with breast cancer spine metastases (Bcsm). Cancer Management and Research 12: 11501–11513 [PMC free article: PMC7667004] [PubMed: 33204161] | Other protocol criteria - not a validated scoring system |
| Zhong, N., Leng, A., He, S. et al. (2019) Surgical outcomes and prognostic factors for patients with gastric cancer spinal metastasis. Cancer Management and Research 11: 6971–6979 [PMC free article: PMC6662173] [PubMed: 31413637] | Outcomes do not match protocol – does not report data relevant to prognostic value of a scoring system - prognostic factor study |
| Zoccali, C., Skoch, J., Walter, C.M. et al. (2016) The Tokuhashi score: effectiveness and pitfalls. European Spine Journal 25(3): 673–678 [PubMed: 26626082] | Study design - systematic review without pooled results/quantitative data, checked for relevant studies |
Excluded economic studies
No economic evidence was identified for this review. See supplementary material 2 for further information.
Appendix K. Research recommendations – full details
Research recommendations for review question: What is the prognostic value of validated scoring systems for determining survival in people with spinal cord compression caused by spinal metastases or direct malignant infiltration of the spine?
No research recommendations were made for this review question.
Appendix L. Study data (AUC data and observed / predicted survival data)
Tables
Table 1Summary of the protocol (PIO table)
| Population |
|
|---|---|
| Index test (clinical prediction model) |
Scoring systems to predict survival of patients with spinal metastases or direct malignant infiltration, for example:
|
| Outcome |
Critical Accuracy of the scoring system for:
Important Accuracy of the scoring system for:
|
ECOG: Eastern Cooperative Oncology Group
Table 2Summary of included studies
| Study | Population | Prognostic tools | Outcomes |
|---|---|---|---|
|
Observational study USA |
N=176 Patients undergoing surgery for metastatic spine disease. Age, mean, years (SD): 60 (12). Sex: female n=71; male n=105. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study UK |
N=199 Patients with spinal metastases. Age, mean, years (SD): 61.6 (12.5). Sex: female n=81; male n=118. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Russia |
N=138 Patients with spinal metastases. Age, median, years (95% CI): 57 (56 – 59). Sex: female n=102; male n=36. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study France |
N=260 Patients with spinal metastases undergoing surgery. Age, mean, years (SD): 59 (11). Sex: female n=143; male n=117. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study UK |
N=90 Consecutive patients undergoing treatment for spinal metastases (surgery, kyphoplasty, transpedicular biopsy). Age, mean, years (range): 64 (32 – 88). Sex: female n=45; male n=45. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Argentina |
N=105 Patients undergoing surgical treatment for vertebral metastases. Age, mean, years (range): 61.5 (16 – 86). Sex: female n=44; male n=61. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Japan |
N=85 Patients undergoing surgery for spinal metastases. Age, mean, years (range): 62.4 (26 – 85). Sex: female n=37; male n=48. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Singapore |
N=87 Patients with spinal metastases from nasopharyngeal carcinoma. Age, mean, years (range): 52 (26-90). Sex: female n=19; male n=68. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Iran |
N=109 Patients with spinal metastases. Age, mean, years (SD): 57 (12). Sex: female n=56; male n=53. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Korea |
N=145 Patients undergoing surgical treatment for spinal metastases. Age, mean, years (SD): 60.0 (10.9). Sex: female n=49; male n=96. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Brazil |
N=117 Patients undergoing surgical treatment for spinal metastases. Age, mean, years (SD): 56 (12). Sex: female n=68; male n=49. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study USA |
N=30 Patients undergoing surgical treatment for renal cell carcinoma spinal metastases. Age, mean, years (range): 57.6 (29 – 79). Sex: female n=7; male n=23. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study UK |
N=201 Patients with spinal metastases managed surgically. Age, mean, years (range): 61 (18 – 86). Sex: female n=74; male n=127. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Brazil |
N=17 Patients undergoing surgery for spinal cord epidural metastasis. Age, mean, years (range): 65 (29-77). Sex: female n=3; male n=14. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study France |
N=739 Patients treated surgically for spinal metastasis (decompressive and/or stabilisation surgery) Age, mean, years (SD): Age at diagnosis 64.05 (12.1). No other data on age reported. Sex: female n=314; male n=425. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study France |
N=148 Patients undergoing surgery for metastatic spinal cord compression. Age, median, years (range): 60 (22 – 87). Sex: female n=71; male n=77. |
| Accuracy of the scoring system for spinal stability:
|
|
Tan 2016a Observational study Singapore |
N=92 Patients with nasopharyngeal carcinoma and skeletal metastases Age, median, years (range): 52 (26 – 90). Sex: female n=19; male n=73. |
| Accuracy of the scoring system for spinal stability:
|
|
Tan 2016b Observational study Singapore |
N=180 Patients with spinal metastases from the lung Age, mean, years (SD): 62.6 (11.6). Sex: female n=74, male n=106. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Singapore |
N=185 Patients with breast cancer spinal metastases Age, mean, years (range): 59.4 (28 – 93). Sex: female n=185, male n=0. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Germany |
N=217 Patients with spinal metastases Age, mean, years (SD): not reported. Sex: female n=103; n=114 male. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Denmark |
N=448 Patients with confirmed spinal metastases who underwent surgical treatment. Age, mean, years (range): 63 (24 – 89). Sex: female n=177; male n=271. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Germany |
N=223 Patients who had surgery for spinal metastases. Age, mean, years (SD): 62.3 (13.3). Sex: female n=95; male n=128. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study Taiwan |
N=427 Patients who had surgery for spinal metastases Age, median, years (IQR): 60 (52 – 67). Sex: female n=166; male n=261. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study China |
N=128 Patients with spinal metastases Age, mean, years (SD): 60.2 (12.0). Sex: female n=37; male n=91. |
| Accuracy of the scoring system for spinal stability:
|
|
Observational study China |
N=151 Patients with spinal metastases from lung cancer Age, mean, years (range): 57 (38 – 76). Sex: female n=64 male n=87. |
| Accuracy of the scoring system for spinal stability:
|
AUC: area under the receiver operating characteristic curve; IQR: Interquartile range; SD: standard deviation; SORG: skeletal oncology research group
Final
Evidence reviews underpinning recommendations 1.9.2 and 1.9.3 in the NICE guideline
This evidence review was developed by NICE
Disclaimer: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.
NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.