Predictive value of seven preoperative prognostic scoring systems for spinal metastases

Abstract

Predicting prognosis is the key factor in selecting the proper treatment modality for patients with spinal metastases. Therefore, various assessment systems have been designed in order to provide a basis for deciding the course of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van der Linden, and Bauer. The scores differ greatly in the kind of parameters assessed. The aim of this study was to evaluate the prognostic value of each score. Eight parameters were assessed for 69 patients (37 male, 32 female): location, general condition, number of extraspinal bone metastases, number of spinal metastases, visceral metastases, primary tumour, severity of spinal cord palsy, and pathological fracture. Scores according to Tokuhashi (original and revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a modified Bauer score without scoring for pathologic fracture. Nineteen patients were still alive as of September 2006 with a minimum follow-up of 12 months. All other patients died after a mean period of 17 months after operation. The mean overall survival period was only 3 months for lung cancer, followed by prostate (7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 months). At univariate survival analysis, primary tumour and visceral metastases were significant parameters, while Karnofsky score was only significant in the group including myeloma patients. In multivariate analysis of all seven parameters assessed, primary tumour and visceral metastases were the only significant parameters. Of all seven scoring systems, the original Bauer score and a Bauer score without scoring for pathologic fracture had the best association with survival (P < 0.001). The data of the present study emphasize that the original Bauer score and a modified Bauer score without scoring for pathologic fracture seem to be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. However, decision for or against surgery should never be based alone on a prognostic score but should take symptoms like pain or neurological compromise into account.

Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

“…The type of primary tumour was not found to be significantly associated with survival in their study. Leithner et al [18] concluded from their retrospective study comparing seven similar scoring systems that the original Bauer score and a modified Bauer score without scoring for pathologic fracture were practicable and highly predictive for outcome and survival.…”

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

“…Leithner et al [14] studied seven different scoring systems that predict survival in metastatic spinal cancer cases. They concluded that Bauer and modified Bauer systems score best among the seven studied in terms of accuracy of prediction.…”

A systematic review of prognostic factors predicting survival in patients with spinal bone metastases

“…These models employ different sets of prognostic factors such as performance score, primary tumor and the presence of visceral metastases to stratify patients with SBM according to survival risk, enabling clinicians to select a more appropriate treatment. Several studies have been undertaken to assess the prognostic value of these models and the factors being used [12,13]. The aim of this systematic review was to identify prognostic factors that are associated with survival in patients with spinal bone metastases in order to help guide development of predictive models.…”