New England Spinal Metastatic Score (NESMS)

Prognoses survival in patients with spinal metastases based on characteristics of the primary tumor location, patient albumin and ambulatory status.

Refer to the text below the score for more information on the prognostic variables and the result interpretation.


The New England Spinal Metastatic Score (NESMS) is a survival prognostic tool that can guide clinicians in decisions associated with the outcomes of spinal metastasis. The NESMS was found to have a superior predictive capacity than alternative prognosis scores such as the Tokuhashi, Bauer or SINS.


Score Interpretation

NESMS Mortality prediction
0 Very high mortality
1 High mortality
2 Moderate mortality
3 Lower mortality

1Is the primary tumor a lung tumor?
2Is the primary tumor a breast/renal/lymphoma/myeloma tumor?
3Is there a single skeletal metastasis?
4Are there any visceral metastases?
5Is the patient ambulatory at presentation?
6Is the patient’s albumin more than or equal to 3.5g/dL?
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The Scoring System Explained

NESMS is a prognostic scoring system for both operative and nonoperative patients with spinal metastases. In consists of 6 items, referring to characteristics of the primary cancer diagnosis, serum albumin levels and ambulatory function.

NESMS Items Points
Is the primary tumor a lung tumor? Yes 0
No 1
Is the primary tumor a breast/renal/lymphoma/myeloma tumor? Yes 1
No 0
Is there a single skeletal metastasis? Yes 1
No 0
Are there any visceral metastases? Yes 0
No 1
Is the patient ambulatory at presentation? Yes 1
No 0
Is the patient’s albumin more than or equal to 3.5g/dL? Yes 1
No 0

The NESMS scoring is as follows: The points assigned to the first 4 questions are added and if the points value is lower than 3, 0 is carried forward and the points from the last 2 questions are added to provide the final score. If the sum of the points from the first 4 questions is 3 or 4, then 2 points are carried forward and added to the points from the last 2 questions.

 

Results Interpretation

This spinal metastasis score ranges from 0 to 3, where:

NESMS Mortality prediction
0 Very high mortality
1 High mortality
2 Moderate mortality
3 Lower mortality

A patient scoring 3 may have a higher life expectancy and benefit from surgical intervention due to favorable tumor characteristics and a high serum albumin showing a better capacity to recover from surgery.

 

Comparison to Established Scores

The original study demonstrated the clinical accuracy of the NESMS for predicting short term mortality following metastatic spinal surgery.

The NESMS has been validated and shown it can be directly applied to patient care, hospital-based practice and health-care policy for prognosticating survival in patients with spinal metastatic disease, regardless of selected treatment strategy.

There are other prognostic scores for spinal metastases such as the Revised Tokuhashi score and the SINS. When comparing the dis-criminative capacity of the predictive scores, the NESMS had the highest C statistic (0.79), followed by the Tokuhashi score (0.67), and the SINS (0.54).

The discriminative capacity of the NESMS was therefore significantly greater than any of the other established predictive tools.

 

References

Original reference

Schoenfeld AJ, Le HV, Marjoua Y, Leonard DA, Belmont PJ Jr, Bono CM, Harris MB. Assessing the utility of a clinical prediction score regarding 30-day morbidity and mortality following metastatic spinal surgery: the New England Spinal Metastasis Score (NESMS). Spine J. 2016; 16(4):482-90.

Validation

Schoenfeld AJ, Ferrone ML, Schwab JH, Blucher JA, Barton LB, Tobert DG, Chi JH, Shin JH, Kang JD, Harris MB. Prospective validation of a clinical prediction score for survival in patients with spinal metastases: the New England Spinal Metastasis Score. Spine J. 2021; 21(1):28-36.

Other references

Schoenfeld AJ, Ferrone ML, Blucher JA, Agaronnik N, Nguyen L, Tobert DG, Balboni TA, Schwab JH, Shin JH, Sciubba DM, Harris MB. Prospective comparison of the accuracy of the New England Spinal Metastasis Score (NESMS) to legacy scoring systems in prognosticating outcomes following treatment of spinal metastases. Spine J. 2022; 22(1):39-48.


Specialty: Oncology

Objective: Prognostic

No. Of Items: 6

Year Of Study: 2016

Abbreviation: NESMS

Article By: Denise Nedea

Published On: May 20, 2024

Last Checked: May 20, 2024

Next Review: May 20, 2029