Expansion of the Inpatient Metastatic Spine Score to Outpatients With Spine Metastases

OBJECTIVES: For inpatients with spinal metastases, the Inpatient Metastatic Spine Score accurately assesses prognosis, with scores of 0 to 3 exhibiting significantly longer survival than scores >3. This study examines the accuracy of this algorithm for outpatients prospectively considered for enrollment in the Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) phase II randomized controlled trial. METHODS: From July 2025 to January 2026, outpatients at an NCI-designated cancer center were evaluated. Prognosis was assessed per an adjusted Metastatic Spine Score adjusted for consisting of: age at presentation (60+ vs. younger), duration of metastatic disease diagnosis (6+ mo vs. sooner), refractory to or on active systemic therapy (yes/no), additional nonspine 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 neurological symptoms=yes) with each category scored a 0 (no) or 1 (yes) and a cumulative score derived. Scores of 0 to 3 were compared with scores >3 and correlated with outcomes. Positive prognosis=time to death/hospice >90 days from presentation. The Fisher test was used for statistical analysis. RESULTS: A positive prognosis was exhibited in 8/9 patients with scores of 0 to 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 an accurate prognostic assessment of outpatients with spine metastases, with scores of 0 to 3 yielding significantly better prognosis than scores >3. These findings also support brain MRI evaluation before 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.