Article
Prognostic accuracy of the revised Tokuhashi score in patients undergoing surgical treatment for spinal metastasis
Die prognostische Genauigkeit des revised Tokuhashi Scores in chirurgisch behandelten Patienten mit spinalen Metastasen
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Authors
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Christoph Wipplinger
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Christoph Orban
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Julia Klingenschmid
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Sara Lener
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Anna Stocsits
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Lukas Grassner
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Sebastian Hartmann
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Austria
| Published: | June 26, 2020 |
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Outline
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Objective: Due to recent advances in cancer therapy and subsequent prolonged survival, spinal metastases are an increasingly common finding in cancer patients. One of the most critical factors for treatment decisions is the estimated life expectancy. In our institution, treatment decisions in cancer patients are made individually in an interdisciplinary board meeting. The revised Tokuhashi score (rTS) has been described as a useful tool for estimating a patient’s life expectancy. In order to determine the prognostic accuracy, we performed a retrospective analysis of patients treated surgically for spinal metastasis at our institution.
Methods: According to Tokuhashi et al., patients with an rTS of 0-8 (group I) have an estimated survival of <6 months and should be treated non-surgically. For patients with an rTS of 9-11 (group II) the estimated survival is assumed between six and 12 months, and palliative surgery such as decompression and stabilization only was recommended. Potentially curative treatment with surgical resection is recommended only in patients with an rTS between 12-15 (group III), and an estimated life expectancy of ≥12 months. In this retrospective analysis, we included patients if they had complete medical records and a sufficient follow-up for evaluating their predicted survival according to Tokuhashi et al.
Results: Sixty-four patients, 19 females and 45 males with an average age of 60± 14 years, were analyzed. Thirty patients were in group I, 25 patients in group II and nine patients in group III. All patients underwent decompressive surgery with or without stabilization. Additionally, tumor resection was performed in 18 patients (60%) in group I, in 14 patients (25%) in group II and in nine patients (100%) in group III. In group I, six patients died within six months, while 24 patients survived longer than six months. Therefore, the predictive accuracy of the rTS was 20%. In group II, the rTS predicted accurately in four patients (16%) while three patients died before six months, and seven patients survived longer than 12 months. In group III, one patient died before 12 months resulting in an accuracy of 89%. The overall accuracy of the rTS was 28%.
Conclusion: In our patient population, the accuracy of the rTS was especially low in patients with a limited estimated life expectancy and we did not adhere to the rTS recommendations. Treatment decisions should always be made on an individual basis, and not solely based on a single scoring system.
