TY - JOUR
T1 - Validation of the prognostic index for spine metastasis (PRISM) for stratifying survival in patients treated with spinal stereotactic body radiation
AU - Florez, Marcus A.
AU - De, Brian
AU - Kowalchuk, Roman
AU - Tang, Chad
AU - Bishop, Andrew J.
AU - Kouzy, Ramez
AU - Amini, Behrang
AU - Briere, Tina
AU - Beckham, Thomas H.
AU - Wang, Chenyang
AU - Li, Jing
AU - Tatsui, Claudio E.
AU - Rhines, Laurence D.
AU - Brown, Paul D.
AU - Merrell, Kenneth
AU - Ghia, Amol J.
N1 - Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2024/12
Y1 - 2024/12
N2 - Purpose: The Prognostic Index for Spinal Metastasis (PRISM) is a scoring system derived from prospective data from a single institution that stratifies patients undergoing spine stereotactic radiosurgery (SSRS) for spinal metastases into subgroups by overall (OS). We sought to further demonstrate its generalizability by performing validation with a large dataset from a second high-volume institution, Mayo Clinic. Methods and materials: Eight hundred seventy-nine patients—424 from Mayo Clinic and 455 from MD Anderson Cancer Center (MDACC)—who received SSRS between 2007 and 2019 were identified. Patients were stratified by PRISM criteria, and overall survival (OS) for the PRISM groups for each cohort was compared using Kaplan-Meier estimations and univariate Cox proportional analyses. Model calibration and concordance indices (C-indices) were calculated for each cohort to assess the quality of the scoring system. Results: Patient and tumor characteristics varied significantly between both cohorts including histology, sex, performance status, and number of organs involved (all P < 0.001). Median OS was 30.3 and 22.1 months for the Mayo and MDACC cohorts, respectively. Kaplan-Meier survival curves revealed robust separation between prognostic groups within both cohorts. The Mayo cohort showed median OS of 57.1, 37.0, 23.7, and 8.8 months for Groups 1, 2, 3, and 4, respectively. Univariate analysis revealed hazard ratios of 3.0 (95 % confidence interval [CI], 1.9–4.9), 5.2 (95 % CI, 3.2–8.3), and 12.9 (95 % CI, 7.8–21.4) for groups 2, 3 and 4, respectively all P < 0.001). The C-indices were 0.69 and 0.66 for the unstratified and stratified scores for the Mayo cohort, and 0.70 and 0.68 for the MDACC cohort, respectively. Conclusion: These data demonstrate robust validation of the PRISM score to stratify OS in patients treated with SSRS by a large external cohort, despite substantial differences among the cohorts. Overall, the PRISM scoring may help guide optimal treatment selection for patients with spine metastases.
AB - Purpose: The Prognostic Index for Spinal Metastasis (PRISM) is a scoring system derived from prospective data from a single institution that stratifies patients undergoing spine stereotactic radiosurgery (SSRS) for spinal metastases into subgroups by overall (OS). We sought to further demonstrate its generalizability by performing validation with a large dataset from a second high-volume institution, Mayo Clinic. Methods and materials: Eight hundred seventy-nine patients—424 from Mayo Clinic and 455 from MD Anderson Cancer Center (MDACC)—who received SSRS between 2007 and 2019 were identified. Patients were stratified by PRISM criteria, and overall survival (OS) for the PRISM groups for each cohort was compared using Kaplan-Meier estimations and univariate Cox proportional analyses. Model calibration and concordance indices (C-indices) were calculated for each cohort to assess the quality of the scoring system. Results: Patient and tumor characteristics varied significantly between both cohorts including histology, sex, performance status, and number of organs involved (all P < 0.001). Median OS was 30.3 and 22.1 months for the Mayo and MDACC cohorts, respectively. Kaplan-Meier survival curves revealed robust separation between prognostic groups within both cohorts. The Mayo cohort showed median OS of 57.1, 37.0, 23.7, and 8.8 months for Groups 1, 2, 3, and 4, respectively. Univariate analysis revealed hazard ratios of 3.0 (95 % confidence interval [CI], 1.9–4.9), 5.2 (95 % CI, 3.2–8.3), and 12.9 (95 % CI, 7.8–21.4) for groups 2, 3 and 4, respectively all P < 0.001). The C-indices were 0.69 and 0.66 for the unstratified and stratified scores for the Mayo cohort, and 0.70 and 0.68 for the MDACC cohort, respectively. Conclusion: These data demonstrate robust validation of the PRISM score to stratify OS in patients treated with SSRS by a large external cohort, despite substantial differences among the cohorts. Overall, the PRISM scoring may help guide optimal treatment selection for patients with spine metastases.
KW - Neoplasm metastasis
KW - Prognosis
KW - Stereotactic radiosurgery
KW - Validation study
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U2 - 10.1016/j.radonc.2024.110570
DO - 10.1016/j.radonc.2024.110570
M3 - Article
C2 - 39362605
AN - SCOPUS:85205917959
SN - 0167-8140
VL - 201
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
M1 - 110570
ER -