RTAD-02 EXPANSION OF THE INPATIENT METASTATIC SPINE SCORE TO OUTPATIENTS WITH SPINE METASTASES: PROSPECTIVE ASSESSMENT ON AN ONGOING PHASE TWO RANDOMIZED CONTROLLED TRIAL
Shearwood McClellandAbstract
Introduction
For patients with spinal metastases, the Inpatient Metastatic Spine Score accurately assesses prognosis, with scores of 0-3 exhibiting significantly longer survival than scores > 3. This study examines the accuracy of this algorithm for outpatients prospectively considered for enrollment on the Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) Phase II randomized controlled trial.
Methods
From 7/2025-1/2026, outpatients at an NCI-designated cancer center were evaluated. Prognosis was assessed per an adjusted Metastatic Spine Score consisting of: age at presentation (60+ vs younger), duration of metastatic disease diagnosis (6+ months vs sooner), refractory to or on active systemic therapy (yes/no), additional non-spine metastatic focus (yes/no), severe malnutrition of chronic disease (yes/no), brain metastases (yes/no), and presenting symptomatology (asymptomatic or spine/back pain alone = no; additional neurologic symptoms = yes) with each category scored a 0 (no) or 1 (yes) and a cumulative score derived for each patient; patients without brain MRI were scored 0.5 for that category. Scores of 0-3 were compared with scores > 3 and correlated with outcomes. Positive prognosis = time to death/hospice > 90 days from presentation. Fisher’s test was used for statistical analysis.
Results
Positive prognosis was exhibited in 8/9 patients with scores of 0-3 (8/8 patients without brain metastases) versus 3/9 patients with scores > 3 (p = 0.0498). The overall accuracy of the Metastatic Spine Score (8/9 positive + 6/9 negative = 14/18 patients) was 78%.
Conclusion
The Metastatic Spine Score provides accurate prognostic assessment of outpatients with spine metastases, with 0-3 scores yielding significantly greater prognosis than scores > 3. These findings also support brain MRI evaluation prior to radiotherapy decisions regarding spinal metastases. This study adds further support for establishing the Metastatic Spine Score as the standard-of-care for accurately evaluating prognosis in this patient population for outpatients as well as inpatients.