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Open Access Research article

A new score predicting the survival of patients with spinal cord compression from myeloma

Sarah Douglas1, Steven E Schild2 and Dirk Rades1*

Author Affiliations

1 Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lubeck, Germany

2 Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA

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BMC Cancer 2012, 12:425  doi:10.1186/1471-2407-12-425

Published: 25 September 2012

Abstract

Background

This study was performed to create and validate a scoring system for the survival of patients with malignant spinal cord compression (SCC) from myeloma.

Methods

Of the entire cohort (N = 216), 108 patients were assigned to a test group and 108 patients to a validation group. In the test group, nine pre-treatment factors including age, gender, Eastern Cooperative Oncology Group performance status (ECOG-PS), number of involved vertebrae, ambulatory status prior to radiotherapy, other bone lesions, extraosseous lesions, interval from first diagnosis of myeloma to radiotherapy of SCC, and the time developing motor deficits were retrospectively analyzed.

Results

On univariate analysis, improved survival was associated with ECOG-PS 1–2 (p = 0.006), being ambulatory (p = 0.005), and absence of other bone lesions (p = 0.019). On multivariate analysis, ECOG-PS (p = 0.036) and ambulatory status (p = 0.037) were significant; other bone lesions showed a strong trend (p = 0.06). These factors were included in the score. The score for each factor was determined by dividing the 12-month survival rate (in%) by 10. The total risk score was the sum of the three factor scores and ranged from 19 to 24 points. Three prognostic groups were designed with the following 12-month survival rates: 49% for 19–20 points, 74% for 21–23 points, and 93% for 24 points (p = 0.002). In the validation group, the 12-month survival rates were 51%, 80%, and 90%, respectively (p < 0.001).

Conclusions

This score appears reproducible, because the 12-month survival rates of both the test and the validation group were very similar. This new survival score can help personalize the treatment of patients with SCC from myeloma and can be of benefit when counseling patients.

Keywords:
Myeloma; Metastatic spinal cord compression; Radiotherapy; Survival prognosis; Scoring system