Prognostic Accuracy of Eight Scoring Systems in Untreated Patients with Spinal Metastases: A Comparative Study.

Introduction: To compare the prognostic accuracy of eight widely used scoring systems and their Primary Tumor-Independent (PTI) versions in untreated patients with spinal metastases (SPM). Methods: Data from 108 untreated patients with SPM diagnosed between 2017 and 2023 were retrospectively analyzed. Prognostic accuracy was assessed for eight scoring systems: Skeletal Oncology Research Group (SORG) Nomogram, New Katagiri score, Revised Tokuhashi Score, Tomita Score, New England Metastatic Spinal Score, Modified Bauer Score, Oswestry Spinal Risk Index, and van der Linden Score. PTI versions were also evaluated by excluding primary tumor information. Predictive accuracy was assessed using receiver operating characteristic analysis at 90 days, 180 days, and 1 year. Results: At 90 days, the New Katagiri score demonstrated the highest predictive accuracy (area under the curve [AUC]=0.788). The SORG Nomogram exhibited the highest accuracy at 180 days (AUC=0.759) and 1 year (AUC=0.749). In PTI analysis, the SORG Nomogram-PTI retained the highest accuracy at 90 days (AUC=0.728) and 180 days (AUC=0.719). Conclusions: The New Katagiri score and the SORG Nomogram demonstrated high prognostic accuracy for untreated SPM patients, with the SORG Nomogram-PTI maintaining strong predictive performance even without primary tumor information. These scoring systems are valuable tools for survival estimation and clinical decision-making in this challenging patient population.