Evaluation and Modification of the Tomita Score in 217 Patients with Vertebral Metastases

Abstract

The Tomita prognosis score consists of the following 3 parameters: growth behavior, evidence of visceral metastases, and/or evidence of bony metastases. Methods: 217 consecutive patients, surgically treated for vertebral metastases of different entities, were studied retrospectively. The score according to Tomita was determined. Results: In the study group, the Tomita score showed significant results for the estimation of life expectancy of the different prognostic groups (p < 0.0001), but the analysis showed a low reliability, i.e. correlation between predicted prognosis and real survival. A modified division of the patients based on the total sum of points allowed a significant separation (p < 0.0001) of patients into 2 prognostic groups with a real survival of more or less than 12 months. Conclusion: In our study, the original Tomita score was not reliable to predict the life expectancy of cancer patients with spinal metastases. Our modification allows a significant differentiation of patients with spinal metastases with a prognosis of more or less than 12 months.

The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

“…Since 2007, and in particular within the past 4 years, many authors have reviewed the established (primarily the Tokuhashi and Tomita scores) prognostic systems and have concluded them to be suboptimal. 16–18,20,28,31,74 Consequentially, multiple authors have suggested modifications of existing scoring systems either by adding new variables, for example, laboratory values, or customizing existing systems to individual primary tumor pathologies. 24,28,31,62,75,76 The potential need to tailor scoring systems to include tumor-specific as well as tumor nonspecific factors was most recently echoed by Luksanapruksa et al in a systematic review and meta-analysis of prognostic factors in patients with spinal metasatses.…”

“…Multiple studies have reported significant association between survival and the Tomita score. 11,23,[28][29][30][31] The simple design of the Tomita score as well as its patient-centered approach has incurred favor as a clinical score to be used independently, or often in combination with the TS. 32,33 Other authors have favored the use of the Tomita score due to the emphasis it places on the biology of the primary tumour.…”

“…34 While the Tomita score is more user friendly than the TS, it has also been reported to have suboptimal reliability when predicting survival. 31 Like the Tokuhashi score, the Tomita has also been found to be inaccurate with regard to specific tumor subtypes. 26,27 Furthermore, the methodology behind the creation of the Tomita score has been criticized for lack of supporting data in the original paper and poor specificity in predicting prognosis.…”

Tokuhashi score and other prognostic factors in 260 patients with surgery for vertebral metastases

“…Two 2007 reports by Ulmar et al assess the Tokuhashi [16] and Tomita [21] scores in a cohort of 217 patients with vertebral metastases. Their results validate the Tokuhashi score and establish its superiority over the Tomita score for predicting survival.…”

Score de Tokuhashi et autres facteurs pronostiques. À propos de 260 patients opérés pour métastase vertébrale

“…La médiane de survie observée dans le groupe Frankel E était de 16 mois (IC 95 % = [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]). Dans le groupe Frankel C-D, la médiane de survie observée était de 6 mois (IC 95 % = [4][5][6][7][8][9]).…”