Research on the predicting power of the revised Tokuhashi system: how much time can surgery give to patients with short life expectancy?

Abstract

Object The primary treatment option for symptomatic metastatic spinal tumors is surgery. Prognostic systems are designed to assist in the establishment of the indication and the choice of surgical methodology. The best-known prognostic system is the revised Tokuhashi system, which has a predictive ability of about 60%. In our study, we are attempting to find the reason for its poor predictive ability, despite its proper separation ability. Methods We have designed a one-center-based retrospective clinical trial, by which we would like to test the feasibility and the inaccuracy of the revised Tokuhashi system. In our database, there are 329 patients who underwent surgery. Statistical analysis was performed. Results A significant increase in survival time was observed in the ‘conservative’ category. Earlier studies reported OS 0.15 at the 180-day control time, in contrast with our 0.38 OS value. The literature suggested supportive care for this category, but in our population, every patient underwent surgery. Our population passes the 0.15 OS value on day 475. We propose an adjustment of the Tokuhashi category scores. We observed significant success in resolving pain. Motor functions were improved or stabilized compared to changes in vegetative dysfunction. Conclusion According to our results, the Tokuhashi scoring system makes very conservative predictions and prefers non-surgical palliative or supportive care. Surgical treatment increases the life expectancy of patients in poor condition. We propose modifying the therapeutic options of the revised Tokuhashi system, taking into consideration modern spine surgery techniques.

Prognosis after Palliative Surgery for Patients with Spinal Metastasis: Comparison of Predicted and Actual Survival

“…In contrast, 19.4% and 5.9% of patients categorized in the intermediate and good survival groups, respectively, based on the revised Tokuhashi score died within 6 months of surgery. Previous studies have suggested that the agreement of the actual survival with that predicted using the revised Tokuhashi score is approximately 60%, and that the predictive accuracy decreases for patients with a life expectancy shorter than 1 year [ 23 , 24 , 25 ]. The new Katagiri score has advantages of including classification of the growth rate of the primary cancer and effects of molecular targeted drugs and sensitivity to hormonal therapy.…”

Prognostic Factors after Surgical Treatment for Spinal Metastases

“…The current development of surgical techniques has given rise to an expanding indication for surgery [ 6 ]. Minimally invasive surgery can be applied to patients with a short life expectancy and poor condition [ 7 , 8 ]. Proper prediction of postoperative prognosis is important when considering surgical indications.…”

Predicting survival of patients with spinal metastatic disease using PathFx 3.0 – A validation study of 668 patients in Sweden

“…Historically, the systems have been based on retrospective studies on cohorts treated several decades ago. Recent evaluations of older scoring systems suggest that their accuracy is questionable and that they tend to underestimate survival, as they lag behind the evolution in oncology ( Carrwik et al., 2019 ; Hibberd and Quan, 2017 ; Pollner et al., 2018 ; Mezei et al., 2020 ; Tabourel et al., 2021 ).…”