Which one is a valuable surrogate for predicting survival between Tomita and Tokuhashi scores in patients with spinal metastases? A meta-analysis for diagnostic test accuracy and individual participant data analysis

Abstract

This study is to estimate the diagnostic accuracy of Tokuhashi and Tomita scores that assures 6-month predicting survival regarded as a standard of surgical treatment. We searched PubMed, EMBASE, European PubMed central, and the Cochrane library for papers about the sensitivities and specificities of the Tokuhashi and/or Tomita scores to estimate predicting survival. Studies with cut-off values of ≥9 for Tokuhashi and ≤7 for Tomita scores based on prior studies were enrolled. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the curve (AUC), and the best cut-off value were calculated via meta-analysis and individual participant data analysis. Finally, 22 studies were enrolled in the meta-analysis, and 1095 patients from 8 studies were included in the individual data analysis. In the meta-analysis, the pooled sensitivity/specificity/DOR for 6-month survival were 57.7 %/76.6 %/4.70 for the Tokuhashi score and 81.8 %/47.8 %/4.93 for Tomita score. The AUC of summary receiver operating characteristic plots was 0.748 for the Tokuhashi score and 0.714 for the Tomita score. Although Tokuhashi score was more accurate than Tomita score slightly, both showed low accuracy to predict 6 months residual survival. Moreover, the best cut-off values of Tokuhashi and Tomita scores were 8 and 6, not 9 and 7, for predicting 6-month survival, respectively. Estimation of 6-month predicting survival to decide surgery in patients with spinal metastasis is quite limited by using Tokuhashi and Tomita scores alone. Tokuhashi and Tomita scores could be incorporated as part of a multidisciplinary approach or perhaps interpreted in the context of a multidisciplinary approach.

Who are the Best Candidates for Decompressive Surgery and Spine Stabilization in Patients With Metastatic Spinal Cord Compression?

“…13,14 Lee et al . 15 estimated the prognostic accuracy of Tokuhashi and Tomita scores in a meta-analysis and concluded that both scores had weak diagnostic evidence due to low sensitivity. Another literature review was conducted to evaluate the accuracy of the revised Tokuhashi score by Zoccali et al ., 16 the authors showed that only 63% patients actually followed the survivorship pattern.…”

“…Such underestimation of life expectancy of scores was also observed in other studies. 15,16 To our knowledge, the Tokuhashi score and other prognostic scoring systems were designed in the 1990s and early 2000s, while the majority of the recent anticancer agents, such as the anti-VEGF therapy, were available from 2005. Patients with spine metastasis are living longer due to the development of targeted therapy, new chemotherapeutic agents, and hormonal therapies.…”

Back to Bayesian: A strategy to enhance prognostication of metastatic spine disease

“…Prognostic performance of the Tokuhashi Score has been reported in several cohort studies and a meta‐analysis conducted by Lee et al We should use the highest level of evidence provided by the meta‐analysis reported by Lee et al The authors reported that a Tokuhashi Score of ≥8 has a sensitivity and specificity of 0.657 and 0.676, respectively, for ≥6‐month survival. Tom has a negative test result because his Tokuhashi Score is <8.…”

“…In contrast the median survival is a continuous variable, that is, it can theoretically take an infinite number of values between 0 and infinity. We can apply the same studies used for dichotomous prognostication (the REVEL trial and the Lee et al meta‐analysis) for continuous prognostication …”

“…The Tokuhashi Score, widely used survival index for these patients, considers performance status, extra‐spinal bone metastases, vertebral metastases, visceral metastases, pathologic diagnosis and neurologic function . The Tokuhashi score has good performance in discriminating between patients who die prior to or survive beyond 6 months …”