Elsevier

World Neurosurgery

Volume 111, March 2018, Pages e1-e6
World Neurosurgery

Original Article
Reliability of Tokuhashi Score to Predict Prognosis: Comparison of 117 Patients

https://doi.org/10.1016/j.wneu.2017.11.033Get rights and content

Background

Spinal metastatic disease compromises the quality of life and prognosis of the patients. Prognosis is an important factor for the decision-making process and needs to be precise in order to adjust the intensity of therapy. The Tokuhashi score is a universal instrument to determine the prognosis. The objective was to analyze the effectiveness of the Tokuhashi score in determining the prognosis of the patients with spine metastasis by comparing the expected survival time from the Tokuhashi score with the survival time observed among surgical patients.

Methods

This retrospective study was performed from October 2008 to October 2015. The inclusion criteria were symptomatic patients with spinal metastasis who underwent spinal cord decompression and had a minimum of 1-year follow-up. The exclusion criteria were patients without histologic confirmation and were lost to follow-up. The Tokuhashi score was applied, and once the expected survival was defined, it was compared with the survival time observed in the follow-up.

Results

The sample studied was 117 patients. The commonly female (58%) and breast spinal metastasis was often observed (25.6%). The patients were followed for a minimum period of 12 months. The actual survival was beyond that estimated by the Tokuhashi score (P < 0.05).

Conclusion

The Tokuhashi score was not reliable to predict the prognosis. Patients with lower scores that surgical treatment was not recommended by the Tokuhashi score had better quality of life and longer survival after surgery. Tokuhashi score is not a precise tool to establish the best therapy and survival in patients with spinal metastasis.

Introduction

The spine is the most common site for skeletal system metastasis, accounting for approximately 50%,1, 2 and is the third site for metastasis after the pulmonary and hepatic systems.3 It is estimated that 5%–10% of cancer patients will develop spinal metastasis,2, 4, 5, 6, 7 and 5%–10% may undergo spinal compression during the course of the disease.8, 9 Advances in chemotherapy and radiotherapy have increased the survival of patients with cancer and, simultaneously, the frequency of metastases.8, 9

The goals of surgical treatment are to prolong patient survival and improve quality of life.10 The most difficult part of the decision-making progress is to adjust the right treatment to the right patient. In order to achieve this goal, it is fundamental that the patient's prognosis has been clearly and precisely defined. Predictive systems for assessing life expectancy were developed to help the physicians to determine the therapeutic strategy. The Tokuhashi prognostic score evaluates the life expectancy and prognosis in patients with secondary spine metastasis and has been described in clinical studies as a valuable tool to determine the indications and proposals for treatment before surgery.11, 12, 13, 14, 15

The objective of the study was to analyze the effectiveness of the Tokuhashi score in determining the prognosis of the patients with spine metastasis by comparing the expected survival time from the Tokuhashi score with the survival time observed from surgical patients.

Section snippets

Study Design

This was a retrospective study of patients who underwent surgery for spinal metastasis from October 2008 to October 2015 at the Neurosurgery Department of the Cristo Redentor Hospital–Conceição Hospital Group–Porto Alegre/RS.

Eligibility

All patients underwent clinical and neurologic examinations, laboratory evaluation, and radiologic examinations to assess the extension of the disease and involvement of other sites rather than the spine. The spine was evaluated by computed tomography and magnetic resonance

Results

During the period of October 2008 to October 2015, 117 patients were evaluated by the neurosurgical service with spine metastasis and eligible for the study.

The mean age was 56 ± 12.5 years, and 59% of cases were diagnosed between 50 and 69 years. The predominant gender was female (n = 68, 58%). The most frequent primary site was the breast (n = 30, 25.6%) followed by the lung (n = 17, 14.5%). Multiple spinal metastases were more common (n = 70, 59.8%). The most frequent segment of the spine

Discussion

Spinal metastases are common manifestations of bone metastasis.17, 18 Prognostic factors of patients with metastatic spinal tumors are used to be taken into account for objective determination of treatment modality.12, 19 The Tokuhashi score is intended to help in the choice of treatment modality by predicting prognosis. However, despite the nonsurgical approach recommended by Tokuhashi for patients with lower scores, in our study, the patients referred for surgery survived longer than the

Conclusion

Despite the nonsurgical approach recommended by the Tokuhashi scale for patients with lower scores, those patients referred for surgery survived longer than the Tokuhashi score predicted. If the Tokuhashi score was adopted, 72 cases (61.5%) had not undergone surgery. The Tokuhashi score is another tool, but not definitive, for the establishment of therapeutic management in patients with spinal metastasis.

Acknowledgments

The authors would like to thank all staff members and professors of the Department of Neurosurgery at Cristo Redentor Hospital for the encouragement to develop this important research.

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      Citation Excerpt :

      Perhaps the most well recognised being the tokuhashi score. De Almeida et al.5 reviewed the reliability of the tokuhashi score in a population of 117 patients who had surgical decompression for metastatic spinal disease. Their analysis concluded that the tokuhashi score was not an accurate tool for prognosis prediction.

    Conflict of interest statement: The authors have no conflicts or disclosures to identify, and ethical standards have been used during the preparation of this manuscript. They also have no financial disclosures to identify, and this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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