Establishment And Validation Of A Novel Survival Prediction Scoring Algorithm For Patients With Non-small-cell Lung Cancer Spinal Metastasis

Lung cancer remains the most common cancer and the leading cause of cancer-related death worldwide,with a 5-year overall survival(OS)rate of 18.1% being observed to date,whose estimated number of deaths was 1.6million annually.About 80% of lung cancer are NSCLC,of which some present with bone metastasis.The most common site of bone metastasis is the spine.The preferred treatment of spinal metastases is still palliative therapy,so whether patients benefit is directly related to their survival time.Therefore,life expectancy has been one of the key factors to select a proper treatment.With the advance of systemic therapy for advanced NSCLC,the survival time of patients has been prolonged,and the accuracy of the previous survival prediction scoring system is progressively lost.At the same time,these patients also have a requirement for a higher quality of life.As the development of surgery and radiotherapy,the metastatic lesions have also been aggressively treated.The benefits of any potential treatment should be balanced against the risks and disease burden for each individual patient.The long-term benefits of an invasive,timely,or costly procedure might not manifest in patients with a short life expectancy.Taken together,there is a need for a practical NSCLC-spinal-metastasis-specific score system to support the individualized treatment strategy making.Section ? [Purpose] The objective of the current study is to develop a scoring algorithm,based on readily available clinical and pathological information that can predict the survival times for patients with NSCLC spinal metastasis.[Methods] We identified 176 consecutive patients with NSCLC spinal metastasis between 2006 and 2017.Twenty-four features,including age,gender,smoking,KPS,paralysis,histological subtype,tumor stage,surgery,EGFR status,CEA,CA125,CA19-9,NSE,SCC,CYFRA21-1,calcium,AKP,albumin,the number of spinal,extra-spinal bone and visceral metastasis,time to metastasis,pathological fracture,and primary or secondary metastasis,were retrospectively analyzed.Features associated with survival in the multivariate analyses were included in a scoring model.[Results] The median follow-up period was 12.00months(95%CI,9.40-14.60).One hundred forty-seven patients died during follow-up,with a median survival of 13.6 months being observed.Multivariate analysis revealed that the following features were associated with survival: age,smoking,CA125,SCC,KPS,and EGFR status.A scoring system based on these features was created to stratify patients into low-risk(0-3),intermediate-risk(4-6)and high-risk(7-10)groups,whose estimated median survival times 29.10,10.40 and 3.90 months,respectively.The Harrell's c-index was 0.72.[Conclusion] In patients with NSCLC spinal metastasis,survival was associated with age,smoking,CA125,SCC,KPS,and EGFR status A scoring system based on these features was devised that can predict the survival times of those patients.This scoring system provides a basis for applying the NOMS framework,and for facilitating individual treatment.Section ? [Purpose] The objective of the current study is to prospectively validated the accuracy and reliability of our NSCLC spinal metastasis survival prediction scoring algorithm.[Methods] This is a prospective observational cohort study.The inclusion criteria for this study is:(1)Diagnosis by biopsy: Non-small-cell lung cancer,including non-squamous carcinoma and squamous cell carcinoma.(2)Diagnosis through both nucleotide bone scan and MRI or PET-CT: spinal metastasis.(3)Age 18-75 years.(4)Have been or is about to be treated according to NCCN panel recommendation.The exclusion criteria for this study is:(1)Diagnosis by biopsy: other tumors.(2)Irregular follow-up and lost follow-up.(3)Withdraw from the study for any reason.The primary end point in this study was death due to any cause.The Kaplan-Meier survival curves and the log-rank test,the median survival times,survival rates,and the Harrell's c-index were calculated and compared with the corresponding data from model group.If the Harrell's c-index decline no greater than 5% compared to the model cohort,the validation result was considered positive.[Results] The patient enrollment period lasted from January 2017 to January 2018.A total of 63 patients were included,consisted of 22 patients in the low risk group,33 in the intermediate risk group,and 8 in the high risk group.Fifty-two patients died during follow-up.The median follow-up was 9.77 months.The median survival was 10.43 months.The median OS of the patients in the low-risk group was 21.63 months,in the intermediate-risk group was 7.80 months,and in the high-risk group was 3.37 months.The Harrell's c–index for the validation group was 0.674,achieved our pre-definition of the positive outcome.Thus,this scoring algorithm appears valid and reproducible.[Conclusion] Our NSCLC spinal metastasis survival prediction scoring model was prospectively validated to be accurate,reliable and reproducible.