학술논문
Prognostic factors for survival and ambulatory status at 8 weeks with metastatic spinal cord compression in the SCORAD randomised trial.
Document Type
Academic Journal
Author
Hoskin PJ; Mount Vernon Cancer Centre Northwood and University of Manchester, United Kingdom. Electronic address: peterhoskin@nhs.net.; Hopkins K; Bristol Centre for Haematology and Oncology, Bristol, United Kingdom.; Misra V; The Christie Hospital, Manchester, United Kingdom.; Holt T; Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.; McMenemin R; The Freeman Hospital Newcastle, United Kingdom.; McKinna F; Royal Sussex County Hospital, Brighton, United Kingdom.; Madhavan K; Southend University Hospital, United Kingdom.; Bates A; Southampton General Hospital, United Kingdom.; O'Rourke N; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.; Lester JF; Velindre Cancer Centre, Cardiff, United Kingdom.; Sevitt T; Kent Oncology Centre, Maidstone, United Kingdom.; Roos D; Royal Adelaide Hospital and University of Adelaide, Australia.; Brown G; Weston Park Hospital, Sheffield, United Kingdom.; Thomas SS; Southend University Hospital, United Kingdom.; Forsyth S; CRUK & UCL Cancer Trials Centre, London, United Kingdom.; Reczko K; CRUK & UCL Cancer Trials Centre, London, United Kingdom.; Hackshaw A; CRUK & UCL Cancer Trials Centre, London, United Kingdom.; O'Hara C; The Christie Hospital, Manchester, United Kingdom.; Lopes A; CRUK & UCL Cancer Trials Centre, London, United Kingdom.
Source
Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8407192 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0887 (Electronic) Linking ISSN: 01678140 NLM ISO Abbreviation: Radiother Oncol Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Metastatic spinal cord compression (MSCC) carries a poor prognosis and management is based on the likelihood of maintaining mobility and predicted survival.
Patients and Method: SCORAD is a randomised trial of 686 patients comparing a single dose of 8 Gy radiotherapy with 20 Gy 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).
Results: 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: 69-81) in the SCORAD validation set and 68% (95%CI: 62-74) 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.
Conclusions: Primary breast or prostate cancer, and good ambulatory status at presentation, are favourable prognostic factors for both survival and ambulation after treatment.
Competing Interests: Conflicts of interest The authors declare no conflicts of interest
(Copyright © 2022 Elsevier B.V. All rights reserved.)
Patients and Method: SCORAD is a randomised trial of 686 patients comparing a single dose of 8 Gy radiotherapy with 20 Gy 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).
Results: 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: 69-81) in the SCORAD validation set and 68% (95%CI: 62-74) 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.
Conclusions: Primary breast or prostate cancer, and good ambulatory status at presentation, are favourable prognostic factors for both survival and ambulation after treatment.
Competing Interests: Conflicts of interest The authors declare no conflicts of interest
(Copyright © 2022 Elsevier B.V. All rights reserved.)