Newswise — Winner of the Brian D. Silber Award, Anick Nater, MD, presented her research, Predictive Factors of Survival in a Surgical Series of Metastatic Epidural Spinal Cord Compression and a Complete External Validation of Eight Multivariable Scoring Systems in a Prospective North American Multi-Centre Study, during the 2018 American Association of Neurological Surgeons (AANS) Annual Scientific Meeting.
For this project, researchers aimed to (1) identify preoperative predictors of survival in adults treated surgically for a single metastatic epidural spinal cord compression (MESCC) lesion; (2) examine how these predictors relate to eight prognostic scoring systems (PSS); and (3) perform the first full external validation of these PSS in accordance to the TRIPOD statement.
One hundred forty-two surgical MESCC patients were enrolled in a prospective, multicenter, North American, cohort study and followed for 12 months or until death. Cox proportional hazards (PH) regressions were used; PH assumption was checked. Non-collinear predictors with <10% missing data, ≥10 events per stratum and p<0.05 in univariable analysis were tested through a backward stepwise selection. Bootstrapping was used for optimism correction. Calibration was examined graphically and discrimination with Harrell c-statistics for the original and revised Tokuhashi, Tomita, modified Bauer, van der Linden, Bartels, OSRI and Bollen. Survival stratified by risk groups was evaluated using the Kaplan-Meier method and log-rank test.
Seven factors were significant in univariable analysis: Tomita tumor grade, sex, organ metastasis, body mass index, preoperative radiotherapy to MESCC, and SF-36v2 Physical Component (PC) and EQ-5D scores. Tomita tumor Grade II/III (HR: 2.897, 95% CI: 1.593-5.267, p=0.0005), organ metastasis (HR: 1.986, 95% CI: 1.229-3.211, p=0.0051), and SF-36v2 PC (HR: 0.946, 95% CI: 0.921-0.971, p<0.0001) were independently associated with survival; corrected discrimination was 0.68 (95% CI: 0.66-0.70). Although calibration could not be optimally assessed, it was poor overall. Bartels had the best discrimination (0.69; 95% CI: 0.66 – 0.72).
Author Block: Lindsay Tetreault, PhD; Branko Kopjar, MD; Paul Arnold, MD; Mark Dekutoski, MD; Joel Finkelstein, MD; Charles Fisher, MD; John France, MD; Ziya Gokaslan, MD; Laurence Rhines, MD; Michael Fehlings, MD
Disclosure: The author reported no conflicts of interest.
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About the 2018 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. The scientific presentations accepted for the 2018 event will represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Find additional information about the 2018 AANS Annual Scientific Meeting and the meeting program here.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 11,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. Fellows of the AANS are board-certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons of Canada or the Mexican Council of Neurological Surgery, A.C. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spinal column, spinal cord, brain, nervous system and peripheral nerves.
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