A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer

Abstract

Purpose Predicted survival of a patient is the most important parameter that helps to guide the treatment of a patient with metastatic spinal cancer. We aimed to investigate the reliability of modified Tokuhashi score in the decisionmaking process in patients with metastatic spinal cancer. Methods We performed a review of our prospectively collected Metastatic Cancer Database over a period of 4 years (2007)(2008)(2009)(2010). Ninety consecutive patients who were treated for metastatic spinal cancer were enrolled. Data review included demographic details, source of primary cancer, duration of symptoms, location of metastases, calculated Karnofsky's performance status, and calculated survival based on modified Tokuhashi score. We divided the patients into 3 groups. Group A included patients with expected survival less than 6 months. Group B included patients with expected survival between 6 and 12 months. Group C included patients whose expected survival was more than 12 months. We compared the calculated expected survival to the actual survival in all three groups with all patients following up to a minimum of 1 year or until death. Statistical analysis was done by Chi-square test and the Fisher Exact test.Results The survival prediction in group C was significantly accurate in 80.9 % patients (P = 0.027). However, in groups A and B, only 36.1 and 9.1 % patients survived, respectively, as per predicted. (P [ 0.05). Conclusions We can conclude from this study that, when used alone, modified Tokuhashi score may not be a reliable tool to predict survival in all patient groups.

Statistical Analysis of the Casuistry of a Sample of Metastatic Disease in the Spine

“…However, it has not been shown to be accurate in determining survival. 11 This study obtained results that agree with the described lack of precision in determining the survival of patients affected by metastatic spinal disease. For the patients in Group A, the survival concordance rate was better (63.4%) than that observed in patients in Group B (30%).…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2013

“…The paper by Gakhar et al [43], which showed that in a retrospective review of some 90 patients, the survival rate was much better in patients who were expected to have a short survival rate as indicated by the score. Indeed 66.6 % of their patients had a different actual survival rate from that predicted by the Tokuhashi score.…”

Moderate precision of prognostic scoring systems in a consecutive, prospective cohort of 544 patients with metastatic spinal cord compression

“…The scoring system was tested again by Tokuhashi in 2009 showing a precision of 88.0 % (Tokuhashi et al 2005(Tokuhashi et al , 2009. Other studies validating the Tokuhashi Revised score on patients with spinal metastases found an overall precision between 71 and 88 % (Yamashita et al 2011;Tokuhashi et al 2009;Ulmar et al 2007b), but recent studies have reported moderateto-low overall precision between 33 and 64 % (Wang et al Lee et al 2013;Gakhar et al 2012;Pointillart et al 2011a, b). In a study from 2012 by Quraishi et al (2013), the Tokuhashi Revised score was validated in a cohort of patients with MSCC with a moderate overall precision on 66 %.…”

“…Because oncological treatment methods are constantly evolving, resulting in improved survival within the individual types of cancer (Pointillart et al 2011;Gakhar et al 2012;Lee et al 2013), and because of the diverse conclusions from studies validating the Tokuhashi Revised and the Tomita scoring systems on patients with spinal metastases, we found it is of relevance to assess the validity of these scoring systems in a large, recent, consecutive, and prospective cohort of patients with MSCC unselected for surgical and non-surgical treatment.…”