European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025
Development and validation of the NOVA score for surgical triage in metastatic spinal cord compression.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Najjar Elie, Khan Shahbaz, Masarwa Rawan, Sahota Opinder, Salem Khalid, Quraishi Nasir A
Аннотация
STUDY DESIGN: Retrospective diagnostic model development and validation study.
OBJECTIVES: To develop and validate the NOVA (Nottingham Oncologic Vertebral Algorithm) Score, a pragmatic, surgeon-oriented tool for predicting 12-month survival in patients with metastatic spinal cord compression (MSCC), and to compare its performance to established prognostic scores and oncologist estimates.
METHODS: Two independent cohorts of patients with MSCC referred for surgical consideration were included from a tertiary spine center: a derivation cohort (n = 184) and a validation cohort (n = 100). Feature selection was performed using random forest analysis, multivariable logistic regression, and permutation-based variable importance. The final NOVA Score incorporated three clinical parameters: Karnofsky Performance Status (KPS), primary tumor category, and presence of extraspinal metastases. The score ranges from 0 to 10, with a threshold of ≥ 7 used to predict > 12-month survival. Predictive performance was assessed using accuracy, F1-score, area under the receiver operating characteristic curve (AUC), Cohen's kappa, and calibration plots.
RESULTS: In the validation cohort, the NOVA Score achieved an accuracy of 71.0%, AUC of 0.693, F1-score of 47.3% for > 12-month survival, and Cohen's kappa of 0.28. Calibration plots showed good agreement in the mid-to-high probability range. Compared to the Revised Tokuhashi Score, OSRI, Modified Bauer Score, and oncologist estimates, NOVA demonstrated superior sensitivity for identifying long-term survivors using only three readily available variables.
CONCLUSIONS: The NOVA Score is a simple, reproducible tool for early prognostication in MSCC. Its minimal input requirements and balanced performance support its utility for surgical triage in multidisciplinary settings. Further external validation is warranted.
OBJECTIVES: To develop and validate the NOVA (Nottingham Oncologic Vertebral Algorithm) Score, a pragmatic, surgeon-oriented tool for predicting 12-month survival in patients with metastatic spinal cord compression (MSCC), and to compare its performance to established prognostic scores and oncologist estimates.
METHODS: Two independent cohorts of patients with MSCC referred for surgical consideration were included from a tertiary spine center: a derivation cohort (n = 184) and a validation cohort (n = 100). Feature selection was performed using random forest analysis, multivariable logistic regression, and permutation-based variable importance. The final NOVA Score incorporated three clinical parameters: Karnofsky Performance Status (KPS), primary tumor category, and presence of extraspinal metastases. The score ranges from 0 to 10, with a threshold of ≥ 7 used to predict > 12-month survival. Predictive performance was assessed using accuracy, F1-score, area under the receiver operating characteristic curve (AUC), Cohen's kappa, and calibration plots.
RESULTS: In the validation cohort, the NOVA Score achieved an accuracy of 71.0%, AUC of 0.693, F1-score of 47.3% for > 12-month survival, and Cohen's kappa of 0.28. Calibration plots showed good agreement in the mid-to-high probability range. Compared to the Revised Tokuhashi Score, OSRI, Modified Bauer Score, and oncologist estimates, NOVA demonstrated superior sensitivity for identifying long-term survivors using only three readily available variables.
CONCLUSIONS: The NOVA Score is a simple, reproducible tool for early prognostication in MSCC. Its minimal input requirements and balanced performance support its utility for surgical triage in multidisciplinary settings. Further external validation is warranted.