Original ArticleReliability of Tokuhashi Score to Predict Prognosis: Comparison of 117 Patients
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.
References (29)
- et al.
Anterior approaches to the thoracic spine in patients with cancer: indications and results
Ann Thorac Surg
(1997) - et al.
Analysis of the predictive role and new proposal for surgical strategies based on the modified Tomita and Tokuhashi scoring systems for spinal metastasis
World J Surg Oncol
(2014) - et al.
Predictors of survival after surgical treatment of spinal metastasis
Neurosurgery
(2011) The management of cancer metastatic to bone
JAMA
(1994)- et al.
A population-based study of surgery for spinal metastases: survival rates and complications
J Bone Joint Surg Br
(2003) - et al.
Cancer statistics
CA Cancer J Clin
(2000) - et al.
Global cancer statistics
CA Cancer J Clin
(1999) - et al.
National inpatient complications and outcomes after surgery for spinal metastasis from 1993–2002
Cancer
(2007) - et al.
A profile of metastatic carcinoma of the spine
Spine (Phila Pa 1976)
(1985) - et al.
Spinal metastases: the obvious, the occult, and the impostors
Spine
(1990)
Management of metastatic spine disease
Curr Opin Support Palliat Care
NCEPOD Report of 1996-7 (National Confidential Enquiry into Patient Outcome and Death, UK) [cited 2010 July]
A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis
Spine
Surgical strategy for spinal metastases
Spine
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2021, Journal of Clinical Orthopaedics and TraumaCitation 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.
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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.