Prognostic Scoring Systems for Spinal Metastases in the Era of Anti-VEGF Therapies

Study Design. Spine Update on prognostic scoring systems for spinal metastases in the era of anti-vascular endothelial growth factor (VEGF) therapies. Objective. To review and discuss the strengths and weaknesses of available scoring systems since the introduction of molecular targeted anticancer agents. Summary of Background Data. Molecular targeted anticancer agents have dramatically improved survival of patients in various cancers, including renal cancer. Methods. Using prognostic scoring systems for spinal metastases and recent survival data of patients with cancers treated with anti-VEGF agents, a review was undertaken, evaluating the strengths and weaknesses of available prognostic scoring systems designed in the 1990s and early 2000s among patients treated with recent agents (available from 2005). Results. All available prognostic scoring systems for spinal metastases include the primary tumor as a key variable. The estimation of life expectancy with these systems is inaccurate in view of recent survival data, as illustrated in renal cancer. The underestimation of life expectancy and subsequent inadequate treatment of spinal metastases may lead to dramatic alteration of the quality of life. Conclusion. The assessment of the available scores in recent cohorts of patients is mandatory to test their current validity and evidence the need for aggressive surgical management. New scoring systems taking into account the gain in survival induced by recent anticancer agents will likely be warranted in a close future.