Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease

Abstract

INTRODUCTION Management of metastatic spinal disease has changed significantly over the last few years. Different prognostic scores are used in clinical practice for predicting survival. The aim of this study was to assess the accuracy of prognostic scores and the role of delayed presentation in predicting the outcome in patients with metastatic spine disease. METHODS Retrospectively, four years of data were collected (2007)(2008)(2009)(2010). Medical records review included type of tumour, duration of symptoms, expected survival and functional status. The Karnofsky performance score was used for functional assessment. Modified Tokuhashi and Tomita scores were used for survival prediction. RESULTS A total of 55 patients who underwent surgical stabilisation were reviewed. The mean age was 63 years (range: 32-87 years). The main primary sources of tumours included myeloma, breast cancer, lymphoma, lung cancer, renal cell cancer and prostate cancer. Of the cases studied, 29 patients had posterior instrumented stabilisation alone, 10 patients had an anterior procedure alone and 16 patients (with an expected survival of more than one year) had both anterior and posterior procedures performed. Twenty-three patients presented with spinal cord compression. The mean follow-up duration was 9 months (range: 1-39 months). Patients who were treated within one week of referral survived longer than anticipated. Patients were divided into three groups based on their expected survival. Actual survival was better in all three groups after surgery. Discrepancies in scores were prominent in patients with myeloma, breast and prostate cancers. Functional outcome was better in patients under 65 years of age. CONCLUSIONS The prognostic scoring systems are not uniformly effective in all types of primary tumours. However, they are useful in decision making for surgical intervention, taking other factors into account, in particular the age of the patient, the type and stage of the primary tumour and general health.

Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

“…In our study, the actual survival after surgery was greater than that predicted by the revised Tokuhashi score. This improved survival following surgical intervention was also seen by Majeed et al [13] in their relatively small series of 55 patients. Surgery has a positive impact on improvement in patients' neurological status and Sioutos et al [14] demonstrated that patients who were ambulatory pre-operatively and those with only one vertebral involvement survived statistically longer than patients who were non-ambulatory and with multilevel disease.…”

“…The revised Tokuhashi score is considered to be a reasonable tool for predicting the prognosis of patients' life expectancy as has been confirmed by numerous authors [8][9][10][11][12][13][14]. In a retrospective review of 246 patients, Tokuhashi and colleagues showed a predictive value of 85.3 % in the group with a score of 0-8, 73.1 % with a score of 9-11 and 95.4 % in the 12-15 group.…”

Risk factors for wound infection in surgery for spinal metastasis

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Surgical treatment of spinal metastasis usually involves greater risk of wound infection (2,3,4,5,6,7) compared to other types of spinal surgery. The risk factors for wound infection in these patients are poorly understood.…”

Assessment of Scores in Decision Making in Metastases of the Spine

“…20,21 Leithner et al 20 proposed the inclusion of multiple myeloma among the malignancies with longer survival times, despite its being a hematological disease rather than a metastatic disease spread from a solid tumor, and suggested that these patients be included in a group with a better prognosis. Thus, in the Tokuhashi score, the primary site would receive 5 points, and in the Tomita score, a classification as a slow-growing primary site would receive 1 point.…”

“…Thus, in the Tokuhashi score, the primary site would receive 5 points, and in the Tomita score, a classification as a slow-growing primary site would receive 1 point. The study by Majeed et al 21 also included patients with myeloma in the Tokuhashi and Tomita scores, given that they are allocated to the same category as patients with metastasis of the prostate and breast and because a similar survival was observed in the study by these authors. In our study we observed great variability in our attempt to include myeloma in these scores.…”