Rades et al developed a score for evaluating patients with metastatic spinal cord compression. This can help to identify patients who have a short life expectancy and who may not benefit from aggressive management. The authors are from the University of Lubeck and Mayo Clinic Scottsdale.
Patient selection: metastatic spinal cord compression
Outcome: death within 2 months
Parameters:
(1) ECOG performance status
(2) type of cancer
(3) additional bone metastases
(4) visceral metastases
(5) interval between cancer diagnosis and diagnosis of spinal cord compression in months
(6) ambulatory status prior to therapy
(7) time to developing motor deficits in days
|
Parameter |
Finding |
Points |
|
ECOG performance |
2 |
0 |
|
|
3 or 4 |
4 |
|
type of cancer |
breast |
1 |
|
|
prostate |
2 |
|
|
myeloma, lymphoma |
1 |
|
|
lung |
3 |
|
|
other |
3 |
|
additional bone metastases |
no |
1 |
|
|
yes |
3 |
|
visceral metastases |
no |
1 |
|
|
yes |
4 |
|
interval from cancer diagnosis to cord compression |
<= 15 months |
3 |
|
|
> 15 months |
1 |
|
ambulatory status |
ambulatory |
1 |
|
|
not ambulatory |
4 |
|
time to onset of motor deficits |
<= 7 days |
4 |
|
|
> 7 days |
1 |
where:
• None of the patients were ECOG 0 or 1.
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 6
• maximum score: 25
• A score >= 19 indicates a patient who may not benefit from aggressive management and who should receive best supportive care.
Performance:
• The sensitivity was 81% and specificity 84%.
• The negative predictive value was 95%.
Specialty: Hematology Oncology, Surgery, general
