Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease
Authors: Mereles Maximiliano , Camino Willhuber Gaston , Valacco Marcelo , Petracchi Matias , Sola Carlos , Gruenberg Marcelo 
Published: May 2015

Introduction

Spinal metastasis can produce pain, deformity, neurological compromise, and, therefore, decrease survival quality and expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. To identify the best operative option, the type of tumor, the systemic involvement, and patient clinical condition are determinants. Tokuhashi et al created a scoring system to estimate survival and to stratify surgical treatment based on well-established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times.

Materials and Methods

From 2004 to 2011, 96 patients with vertebral metastasis, consecutively operated by the same surgical team, were enrolled and retrospectively analyzed in this study. Patients included have a known primary tumor, were older than 18 years, had no previous related surgery, and were preoperatively evaluated with the Tokuhashi score. Six patients without confirmed date of death were excluded. Hematopoietic tumors were not considered metastatic lesions. Primary tumor, tumoral location, neurological involvement, Tokuhashi score, complications, and survival time were evaluated. In all cases radiograph, CT scan, and magnetic resonance imaging were assessed. Patients' average age was 59 years and main tumor locations were as follows: kidney (25%), lung (19%), and breast (19%).

Results

Group 1 included 45 patients with a scoring prediction of less than 6 months survival (TS 0–8), 7 patients from this group survived more than 6 months, correspondence was 84.4%. In Group 2, with 27 patients with a scoring prediction between 6 and 12 months (TS 9–11), 2 patients survived less than 6 months and 11 more than 12 months, with 51.8% correspondence. Group 3, with 18 patients, and a predicted survival of more than 12 months (TS 12–15) had 100% correspondence. The Tokuhashi general correspondence rate was 77.7%. Sensitivity and specificity of Tokuhashi score were 77.7% and 88.8%, respectively, with a positive predictor value of 77.7%. According to the most frequent primary tumor diagnosis, survival time was 19 months for breast, 28 for thyroid, 26.5 for prostate, and 5.1 for lung, with a mean survival time of 15 months. Correspondence rates related to primary tumor were 82% in lung, 78% in kidney, and 65% in breast, respectively.

Conclusion

In our series, the Tokuhashi general correspondence was 77.7%; similar results were found in the original and revised Tokuhashi reports, and other authors found a lower correspondence, nevertheless, most of them included hematopoietic tumors. The lower correspondence observed in Group 2 (51,8%) was negatively influenced by the most common primary tumor in this group, breast carcinoma, with 65%, compared with lung 82% and kidney 78%. For our practice, Tokuhashi scoring constitutes a useful tool to predict survival, with a sensitivity and specificity of 77.7% and 88.8%, respectively. Breast tumors positively influenced by medical treatment have less correspondence than other tumors and should be considered on case-by-case basis.