Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases

Ulmar, Benjamin; Huch, Klaus; Naumann, Ulrike; Catalkaya, Sibel; Cakir, Balkan; Gerstner, Susanne; Reichel, Heiko

doi:10.1016/j.ejso.2006.11.018

Cited by 59 publications

(39 citation statements)

References 19 publications

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“…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.…”

Section: Discussionmentioning

confidence: 88%

“…In a prospective study, Yamashita et al [11] found in a study of patients with MSCC that the actual survival matched the predicted based on the revised Tokuhashi score in 79 %. In a retrospective study of 217 patients, Ulmar et al [9] concluded that this score showed the highest reliability between the real and predicted survival, with a predictive value of 70.9 %. In another retrospective study of 109 patients, Mollahoseini et al [15] found the revised Tokuhashi scoring system to be highly predictive of the survival in patients with spinal metastases in Iran although the predicted value for the individual scoring groups was not calculated in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few reports have been published which have evaluated the revised Tokuhashi scoring system in a mixed population of patients with various forms cancer [8][9][10][11]. Furthermore, our own experience suggested that survival in patients was often greater than what was predicted by this scoring system.…”

Section: Introductionmentioning

confidence: 94%

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

et al. 2013

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Purpose The revised Tokuhashi score has been widely used to evaluate indications for surgery and predict survival in patients with metastatic spinal disease. Our aim was to analyse the actual survival time of patients treated for metastatic spinal cord compression (MSCC) in comparison with the predicted survival based on the revised Tokuhashi score. This would thereby allow us to determine the overall predictive value of this scoring system. Methods This study was a semi-prospective clinical study of all patients with MSCC presenting to our unit over 8 years-data from October 2003 to December 2009 were collected retrospectively and from December 2009, all data collected prospectively to October 2011. Patients were divided into three groups-Group 1 (Tokuhashi score 0-8, n = 84), Group 2 (Tokuhashi score 9-11, n = 83) and Group 3 (Tokuhashi score 12-15, n = 34). Data collected included demographic data, primary tumour histology, surgery type and complications, neurological outcome (Frankel grade) and survival. Results A total of 233 patients with MSCC were managed surgically in our unit during this time. Out of these complete data were available on 201 patients for analysis.Mean age of patients was 61 years (range 18-86; 127 M, 74 F). The primary tumour type was Breast (n = 29, 15 %), Haematological (n = 28, 14 %), Renal (n = 26, 13 %), Prostate (n = 26, 13 %), Lung (n = 23, 11 %), Gastro-intestinal (n = 11, 5 %), Sarcoma (n = 9, 4 %) and others (n = 49, 24 %). All patients included in the study had surgical intervention in the form of decompression and stabilisation. Posterior decompression and stabilisation was performed in 171 patients (with vertebrectomy in 31), combined anterior and posterior approaches were used in 18 patients and 12 had an anterior approach only. The overall complication rate was 19 % (39/201)-the most common being wound infection (n = 15, 8 %). There was no difference in the neurological outcome (Frankel grade) between Groups 1 and 2 (p = 0.34) or Groups 2 and 3 (p = 0.70). However, there was a significant difference between Groups 1 and 3 (p = 0.001), with Group 3 having a significantly better neurological outcome. Median survival was 93 days in Group 1, 229 days in Group 2 and 875 days in Group 3 (p = 0.001). The predictive value between the actual and predicted survival was 64 % (Group 1), 64 % (Group 2) and 69 % (Group 3). The overall predictive value of the revised Tokuhashi score using Cox regression for all groups was 66 %. Conclusion We would conclude that although the predictive value of the Tokuhashi score in terms of survival time is at best modest (66 %), the fact that there were statistically significant differences in survival between the groups looked at in this paper indicates that the scoring system, and the components which it consists of, are important in the evaluation of these patients when considering surgery.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…O comprometimento vertebral nas metástases e no MM prejudicam não só a função mecânica de sustentação da coluna, mas também a qualidade de vida destes pacientes, em decorrência da presença de quadro doloroso ou da lesão neurológica associada 1,3,[5][6][7][8][9][10] . A correlação entre a taxa de sobrevida e estes índices é contestada por muitos autores, e sua aplicabilidade para o MM ainda não foi avaliada 6,[13][14][15][16] . Em virtude da semelhança de comportamento, história natural e de tratamento entre os portadores de metástase e MM na coluna, estudamos a aplicabilidade destes índices nos portadores de fratura patológica por MM na coluna.…”

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Fratura na coluna vertebral por mieloma múltiplo: correlação entre sobrevida e índices de Tomita e Tokuhashi

Avanzi¹,

Landim²,

Meves³

et al. 2009

Coluna/Columna

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“…In all cases, the main parameters used to estimate prognosis are preoperative ambulatory capacity, Karnofsky performance status, RT, primary cancer type, presence of extraspinal metastasis, and number of spinal segments with metastasis. Additionally, pain on presentation and body mass index 25-30 kg/m 2 have been identified as predictors of poor outcome 21,22,23,24,25 .…”

Section: Discussionmentioning

confidence: 99%

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

Oliveira

Rotta

Botelho

2015

Arq. Neuro-Psiquiatr.

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The spine is the most common site for skeletal metastasis in patients with malignancy. Approximately half of all patients with an advanced malignancy have evidence of spinal involvement. Surgical treatment remains a source of debate, and prognostic factors need to be well established to allow an appropriate decision regarding treatment modalities 1,2,3,4,5 .Vertebral involvement in such patients is associated with worse morbidity and mortality rates, impairing prognosis. Quantification of vertebral involvement, vertebral canal invasion, neurological status, general health status, and malignancy prognosis determined by primary tumor histology are paramount factors for surgical planning and definition of therapeutic targets 6,7,8,9,10 .We conducted a survival analysis in a sample of patients with metastatic spinal disease to determine factors associated with survival. METHODThe study sample consisted of patients with vertebral metastases consecutively admitted from July 2010 to January ABSTRACTSpine is the most common site for skeletal metastasis in patients with malignancy. Vertebral involvement quantification, neurological status, general health status and primary tumor histology are factors to set surgical planning and therapeutic targets. We evaluated the impact of general clinical and neurological status, histologic type and surgery in survival. Method: The study sample consisted of consecutive patients admitted from July 2010 to January 2013 for treatment. Results: Sixty eight patients were evaluated. 23 were female and 45 were male. Main primary neoplasic sites were: breast, prostate, lung/pleura and linfoproliferative. Thirty three out of 68 received surgical treatment, 2 received percutaneous biopsy and 33 had nonsurgical treatment. Survival: Log Rank curves revealed no statistical significant difference according to histological type, surgical approach and Frankel Score. Karnofsky Score was statistically different. Conclusion: Histological type and clinical status were statistically associated with life expectancy in vertebral metastatic disease.Keywords: neoplasm metastasis, spinal diseases, prognosis. RESUMOA coluna vertebral é o sítio mais comum de metastases ósseas. A quantificação do acometimento vertebral, o status neurológico, status clínico e histologia do tumor primário são fatores importantes para planejamento cirúrgico e metas terapêuticas. Nós avaliamos o impacto do status clinico geral e neurológico, tipo histológico e cirurgia na sobrevida de pacientes com metástases espinhais. Método: A amostra consistiu de pacientes consecutivamente admitidos de Julho de 2010 a Janeiro de 2013. Resultados: Sessenta e oito pacientes foram avaliados. 23 eram mulheres e 45 eram homens. Os principais sítios primários foram mama, próstata, pulmão e linfoproliferativos. Trinta e três realizaram tratamento cirúrgico, 2 realizaram biópsia percutânea e 33 tiveram tratamento conservador e radioterapia. Conclusão: As curvas Log Rank não revelaram significância quanto à cirurgia e escore de Frankel, mas revelaram as...

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Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases

Cited by 59 publications

References 19 publications

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

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

Fratura na coluna vertebral por mieloma múltiplo: correlação entre sobrevida e índices de Tomita e Tokuhashi

Survival analysis in patients with metastatic spinal disease: the influence of surgery, histology, clinical and neurologic status

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