The revised Tokuhashi score; analysis of parameters and assessment of its accuracy in determining survival in patients afflicted with spinal metastasis
To determine the significance of each parameter of the revised Tokuhashi score and identify which is associated with survival.
Spinal metastases are common and can be a challenging medical issue. Treatment options depend on patients’ prognosis. Many scoring systems in the literature help estimate prognosis, such as the Tokuhashi, revised Tokuhashi, and Tomita scoring systems.
A retrospective review of all patients from 2003 to 2012 treated for spinal metastases in one center was conducted. Imaging, pathology, and charts were reviewed to determine the modified Tokuhashi scores. Scores were then compared to the actual documented survival. Univariate and multiple regression analyses were used to assess the importance of each individual parameter and survival time. Linear regression was used to determine the relationship between the Tokuhashi score and weighted Tokuhashi score with survival time.
A total of 126 patients were reviewed. All parameters in the revised Tokuhashi score were significantly associated with survival time except for primary site using univariate analysis. Only the number of spinal metastases and metastasis to major organs showed statistical significance when multiple variable analysis was used.
A number of spinal metastases and metastasis to major organs were the most important predictors of actual survival. Modification to the score based on population characteristics would help better identify patients with spinal metastases that can benefit from surgery.
KeywordsSpine metastases Tokuhashi score Prognosis Modified Tokuhashi score Outcome
Compliance with ethical standards
Conflict of interest
None of the authors received financial support for this study. The authors declare that there is no conflict of interests regarding the publication of this paper.
- 7.Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K (2010) Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Euro Spine J Off Publ Euro Spine Soc Euro Spinal Deform Soc Euro Sect Cerv Spine Res Soc 19:215–222. doi: 10.1007/s00586-009-1252-x CrossRefGoogle Scholar
- 9.Nathans LL, Oswald FL, Nimon K (2012) Interpreting multiple linear regression: a guidebook of variable importance. Pract Assess Res Eval 17:1–19Google Scholar
- 12.Quraishi NA, Manoharan SR, Arealis G, Khurana A, Elsayed S, Edwards KL, Boszczyk BM (2013) Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Euro Spine J Off Publ Euro Spine Soc Euro Spinal Deform Soc Euro Sect Cerv Spine Res Soc 22(Suppl 1):S21–26. doi: 10.1007/s00586-012-2649-5 CrossRefGoogle Scholar
- 13.Dardic M, Wibmer C, Berghold A, Stadlmueller L, Froehlich EV, Leithner A (2015) Evaluation of prognostic scoring systems for spinal metastases in 196 patients treated during 2005-2010. Euro Spine J Off Publ Euro Spine Soc Euro Spinal Deform Soc Euro Sect Cerv Spine Res Soc 24:2133–2141. doi: 10.1007/s00586-014-3482-9 CrossRefGoogle Scholar
- 14.Yucel B, Celasun MG, Oztoprak B, Hasbek Z, Bahar S, Kacan T, Bahceci A, Seker MM (2015) The negative prognostic impact of bone metastasis with a tumor mass. Clinics (Sao Paulo, Brazil) 70:535–540. doi: 10.6061/clinics/2015(08)01
- 15.Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Euro Spine J Off Publ Euro Spine Soc Euro Spinal Deform Soc Euro Sect Cerv Spine Res Soc 17:1488–1495. doi: 10.1007/s00586-008-0763-1 CrossRefGoogle Scholar
- 19.Park S, Lee C, Chung S, Lee K (2015) How accurately can tokuhashi score system predict survival in the current practice for spinal metastases?: prospective analysis of 145 consecutive patients between 2007 and 2013. J Spinal Disorders Techn 28:E219–224. doi: 10.1097/bsd.0000000000000225 CrossRefGoogle Scholar
- 20.Eap C, Tardieux E, Goasgen O, Bennis S, Mireau E, Delalande B, Cvitkovik F, Baussart B, Aldea S, Jovenin N, Gaillard S (2015) Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases. Orthop Traumatol Surg Res OTSR 101:483–488. doi: 10.1016/j.otsr.2015.03.007 CrossRefPubMedGoogle Scholar
- 22.Batista N, Tee J, Sciubba D, Sahgal A, Laufer I, Weber M, Gokaslan Z, Rhines L, Fehlings M, Patel S, Raja Rampersaud Y, Reynolds J, Chou D, Bettegowda C, Clarke M, Fisher C (2016) Emerging and established clinical, histopathological and molecular parametric prognostic factors for metastatic spine disease secondary to lung cancer: helping surgeons make decisions. J Clin Neurosci Off J Neurosurg Soc Australasia. doi: 10.1016/j.jocn.2016.05.023 Google Scholar
- 23.Sciubba DM, Goodwin CR, Yurter A, Ju D, Gokaslan ZL, Fisher C, Rhines LD, Fehlings MG, Fourney DR, Mendel E, Laufer I, Bettegowda C, Patel SR, Rampersaud YR, Sahgal A, Reynolds J, Chou D, Weber MH, Clarke MJ (2016) A systematic review of clinical outcomes and prognostic factors for patients undergoing surgery for spinal metastases secondary to breast cancer. Global Spine J 6:482–496. doi: 10.1055/s-0035-1564807 CrossRefPubMedGoogle Scholar
- 25.Lee CH, Chung CK, Jahng TA, Kim KJ, Kim CH, Hyun SJ, Kim HJ, Jeon SR, Chang UK, Lee SH, Moon SH, Majeed H, Zhang D, Gravis G, Wibmer C, Kumar N, Moon KY, Park JH, Tabouret E, Fuentes S (2015) Which one is a valuable surrogate for predicting survival between Tomita and Tokuhashi scores in patients with spinal metastases? A meta-analysis for diagnostic test accuracy and individual participant data analysis. J Neurooncol 123:267–275. doi: 10.1007/s11060-015-1794-1 CrossRefPubMedGoogle Scholar