Multicentre external validation of the new England spinal metastasis score (NESMS) in operative and nonoperative patients with metastatic spinal cord compression.

Abstract

Metastatic spinal cord compression (MSCC) presents complex treatment dilemmas where predicting survival is crucial for clinical decision-making. The New England Spinal Metastasis Score (NESMS) has shown promise, but external validation is needed to confirm its broader applicability. Patients were assigned NESMS retrospectively based on ambulatory status, serum albumin level, and modified Bauer score. This retrospective multicentre study included 322 adult patients with radiologically confirmed MSCC who presented for initial treatment over a 3-year period at 2 partner institutions. The primary outcome was mortality at 12 months, with secondary outcomes of mortality at 3 and 6 months. Kaplan-Meier survival analysis and multivariate logistic regression were used to evaluate NESMS performance in predicting mortality and its discriminative capacity, while adjusting for potential confounders. The cohort had a median age of 70 years, with 65% male patients. Overall 12-month mortality was 75%. NESMS demonstrated excellent discriminative capacity for predicting 12-month mortality (c-statistic 0.82, p<.001) with clear stepwise differences in survival between NESMS levels (mortality: NESMS 0=98%, NESMS 1=88%, NESMS 2=75%, NESMS 3=46%). Multivariate analysis confirmed significantly greater odds of mortality with decreasing NESMS (NESMS 0: OR 35.92, CI 6.90-662.6; NESMS 1: OR 6.97, CI 3.22-16.02; NESMS 2: OR 2.69, CI 1.35-5.42; all p<.05 compared to NESMS 3). Operative management was associated with significantly lower mortality (OR 0.28, CI 0.15-0.51; p<.001). This study externally validates the usefulness of the NESMS in predicting survival for both operative and nonoperative patients with MSCC. Further, we observed clear stepwise increases in mortality with worsening NESMS.