Prognostic factors for survival and ambulatory status at 8 weeks with metastatic spinal cord compression in the SCORAD randomised trial.

Metastatic spinal cord compression (MSCC) carries a poor prognosis and management is based on the likelihood of maintaining mobility and predicted survival.

SCORAD is a randomised trial of 686 patients comparing a single dose of 8Gy radiotherapy with 20Gy in 5 fractions. Data was split into a training set (412, 60%) and a validation set (274, 40%). A multivariable Cox regression for overall survival (OS) and a logistic regression for ambulatory status at 8 weeks were performed in the training set using baseline factors and a backward selection regression to identify a parsimonious model with p≤0.10. Receiver Operating Characteristic (ROC) analysis evaluated model prognostic performance in the validation set. Validation of the final survival model was performed in a separate registry dataset (n=348).

The survival Cox model identified male gender, lung, gastrointestinal, and other types of cancer, compression at C1-T12, presence of non-skeletal metastases and poor ambulatory status all significantly associated with worse OS (all p<0.05). The ROC AUC for the selected model was 75% (95%CI: 69 to 81) in the SCORAD validation set and 68% (95%CI: 62 to 74) in the external validation registry data. The logistic model for ambulatory outcome identified primary tumour breast or prostate, ambulatory status grade 1 or 2, bladder function normal and prior chemotherapy all significantly associated with increased odds of ambulation at 8 weeks (all p<0.05). The ROC AUC for the selected model was 72.3% (95% CI 62.6-82.0) in the validation set.

Primary breast or prostate cancer, and good ambulatory status at presentation, are favourable prognostic factors for both survival and ambulation after treatment.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2022 May 23 [Epub ahead of print]

Peter J Hoskin, Kirsten Hopkins, Vivek Misra, Tanya Holt, Rhona McMenemin, Fiona McKinna, Krishnaswamy Madhavan, Andrew Bates, Noelle O'Rourke, Jason F Lester, Tim Sevitt, Daniel Roos, Gillian Brown, Sharon Shibu Thomas, Sharon Forsyth, Krystyna Reczko, Allan Hackshaw, Catherine O'Hara, Andre Lopes

Mount Vernon Cancer Centre Northwood and University of Manchester, United Kingdom. Electronic address: ., Bristol Centre for Haematology and Oncology Bristol, United Kingdom., The Christie Hospital Manchester, United Kingdom., Princess Alexandra Hospital, University of Queensland Brisbane Australia, Australia., The Freeman Hospital Newcastle, United Kingdom., Royal Sussex County Hospital Brighton, United Kingdom., Southend University Hospital, United Kingdom., Southampton General Hospital, United Kingdom., The Beatson West of Scotland Cancer Centre Glasgow, United Kingdom., Velindre Cancer Centre Cardiff, United Kingdom., Kent Oncology Centre Maidstone, United Kingdom., Royal Adelaide Hospital and University of Adelaide Australia., Weston Park Hospital, Sheffield, United Kingdom., CRUK & UCL Cancer Trials Centre, London, United Kingdom.

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