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Journal of Neuro-Oncology

, Volume 123, Issue 2, pp 267–275 | Cite as

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

  • Chang-Hyun Lee
  • Chun Kee Chung
  • Tae-Ahn Jahng
  • Ki-jeong Kim
  • Chi Heon Kim
  • Seung-Jae Hyun
  • Hyun-Jib Kim
  • Sang Ryong Jeon
  • Ung-Kyu Chang
  • Sun-Ho Lee
  • Seong-Hwan Moon
  • Haroon Majeed
  • Dan Zhang
  • Gwenaelle Gravis
  • Christine Wibmer
  • Naresh Kumar
  • Kyung Yun Moon
  • Jin Hoon Park
  • Emeline Tabouret
  • Stephane Fuentes
Clinical Study

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.

Keywords

Meta-analysis Metastasis Spine Tokuhashi Tomita Survival Prognosis 

Notes

Conflict of interest

None of the authors have any financial interests in the subject under discussion in this paper.

Ethics committee approval

The study was approved by the institutional review board of Seoul National University Hospital (E-1411-049-624).

Supplementary material

11060_2015_1794_MOESM1_ESM.tif (2.9 mb)
ROC plots by Tokuhashi primary cancer score. ROC curve and AUC are not quite different each other. Tokuhashi primary cancer score of 2 (asterisk), as names ‘others’ shows the smallest AUC. Tokuhashi primary cancer score of 4 (sword), as named ‘rectum’, shows the largest AUC. (TIFF 2962 kb)
11060_2015_1794_MOESM2_ESM.tif (1.6 mb)
ROC plots of Tokuhashi, Tomita, and chimeric Tokuhashi scores. The AUC is 0.728 for the Tokuhashi and 0.718 for the Tomita scores, and 0.752 for the chimeric Tokuhashi scores. The adequate cut-off value is 8 for the Tokuhashi and chimeric Tokuhashi scores, and 6 for the Tomita score. (TIFF 1588 kb)

References

  1. 1.
    Choi D, Crockard A, Bunger C, Harms J, Kawahara N, Mazel C, Melcher R, Tomita K (2010) Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J 19:215–222. doi: 10.1007/s00586-009-1252-x CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Yamashita T, Siemionow KB, Mroz TE, Podichetty V, Lieberman IH (2011) A prospective analysis of prognostic factors in patients with spinal metastases: use of the revised tokuhashi score. Spine 36:910–917. doi: 10.1097/Brs.0b013e3181e56ec1 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  3. 3.
    Lee C-H, Kwon J-W, Lee J, Hyun S-J, Kim K-J, Jahng T-A, Kim H-J (2014) Direct decompressive surgery followed by radiotherapy versus radiotherapy alone for metastatic epidural spinal cord compression. Spine 39:E587–E592. doi: 10.1097/brs.0000000000000258 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  4. 4.
    Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  5. 5.
    Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine 30:2186–2191 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  6. 6.
    Tokuhashi Y, Uei H, Oshima M, Ajiro Y (2014) Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop 5:262–271. doi: 10.5312/wjo.v5.i3.262 CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spin 15:1110–1113 (Phila Pa 1976) CrossRefGoogle Scholar
  8. 8.
    Yang SB, Cho W, Chang UK (2012) Analysis of prognostic factors relating to postoperative survival in spinal metastases. J Korean Neurosurg Soc 51:127–134. doi: 10.3340/jkns.2012.51.3.127 CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Ulmar B, Huch K, Naumann U, Catalkaya S, Cakir B, Gerstner S, Reichel H (2007) Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases. EJSO 33:914–919CrossRefPubMedGoogle Scholar
  10. 10.
    Gakhar H, Swamy GN, Bommireddy R, Calthorpe D, Klezl Z (2013) A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer. Eur Spine J 22:565–568CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Papastefanou S, Alpantaki K, Akra G, Katonis P (2012) Predictive value of Tokuhashi and Tomita scores in patients with metastatic spine disease. Acta Orthop Traumatol Turc 46:50–56CrossRefPubMedGoogle Scholar
  12. 12.
    Padalkar P, Tow B (2011) Predictors of survival in surgically treated patients of spinal metastasis. Indian J Orthop 45:307–313. doi: 10.4103/0019-5413.82333 CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Kim J, Lee SH, Park SJ, Chung SS, Kim ES, Eoh W, Lee CS, Lee SH (2014) Analysis of the predictive role and new proposal for surgical strategies based on the modified Tomita and Tokuhashi scoring systems for spinal metastasis. World J Surg Oncol 12:245. doi: 10.1186/1477-7819-12-245 CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Wang M, Jensen AB, Morgen SS, Wu CS, Sun M, Li H, Dahl B, Bunger CE (2014) Survival analysis of breast cancer subtypes in spinal metastases patients. Spine 39:1620–1627. doi: 10.1097/BRS.0000000000000473 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  15. 15.
    Wibmer C, Leithner A, Hofmann G, Clar H, Kapitan M, Berghold A, Windhager R (2011) Survival analysis of 254 patients after manifestation of spinal metastases: evaluation of seven preoperative scoring systems. Spine 36:1977–1986 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  16. 16.
    Ogihara S, Seichi A, Hozumi T, Oka H, Ieki R, Nakamura K, Kondoh T (2006) Prognostic factors for patients with spinal metastases from lung cancer. Spine 31:1585–1590. doi: 10.1097/01.brs.0000222146.91398.c9 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  17. 17.
    Morgen SS, Nielsen DH, Larsen CF, Sogaard R, Engelholm SA, Dahl B (2014) Moderate precision of prognostic scoring systems in a consecutive, prospective cohort of 544 patients with metastatic spinal cord compression. J Cancer Res Clin Oncol 140(12):2059–2066. doi: 10.1007/s00432-014-1776-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Wang M, Bunger CE, Li H, Wu C, Hoy K, Niedermann B, Helmig P, Wang Y, Jensen AB, Schattiger K, Hansen ES (2012) Predictive value of tokuhashi scoring systems in spinal metastases, focusing on various primary tumor groups: evaluation of 448 patients in the aarhus spinal metastases database. Spine 37:573–582. doi: 10.1097/Brs.0b013e31822bd6b0 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  19. 19.
    Aoude A, Amiot L-P (2014) A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis. Can J Chiropr 57:188–193Google Scholar
  20. 20.
    Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM, Group Q (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536. doi: 10.7326/0003-4819-155-8-201110180-00009 CrossRefPubMedGoogle Scholar
  21. 21.
    Tabouret E, Cauvin C, Fuentes S, Esterni B, Adetchessi T, Salem N, Madroszyk A, Goncalves A, Casalonga F, Gravis G (2013) Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression. Spine J S1529–9430(13):00711. doi: 10.1016/j.spinee.2013.06.036 Google Scholar
  22. 22.
    Park JH, Rhim SC, Jeon SR (2011) Efficacy of decompression and fixation for metastatic spinal cord compression: analysis of factors prognostic for survival and postoperative ambulation. J Korean Neurosurg Soc 50:434–440. doi: 10.3340/jkns.2011.50.5.434 CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Majeed H, Kumar S, Bommireddy R, Klezl Z, Calthorpe D (2012) Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease. Ann R Coll Surg Engl 94:28–33CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Lee BH, Kim TH, Chong HS, Moon ES, Park JO, Kim HS, Kim SH, Lee HM, Cho YJ, Kim KN, Moon SH (2013) Prognostic factor analysis in patients with metastatic spine disease depending on surgery and conservative treatment: review of 577 cases. Ann Surg Oncol 20:40–46. doi: 10.1245/s10434-012-2644-4 CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang D, Xu W, Liu T, Yin H, Yang X, Wu Z, Xiao J (2013) Surgery and prognostic factors of patients with epidural spinal cord compression caused by hepatocellular carcinoma metastases: retrospective study of 36 patients in a single center. Spine 38:E1090–E1095 (Phila Pa 1976) CrossRefPubMedGoogle Scholar
  26. 26.
    Moon KY, Chung CK, Jahng TA, Kim HJ, Kim CH (2011) Postoperative survival and ambulatory outcome in metastatic spinal tumors : prognostic factor analysis. J Korean Neurosurg Soc 50:216–223. doi: 10.3340/jkns.2011.50.3.216 CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Kumar N, Tan JJ, Zaw AS, Lim JL, Wai KL, Malhotra R, Loh TK, Liu GK, Thambiah J (2014) Evaluation of scoring systems and prognostic factors in patients with spinal metastases from nasopharyngeal carcinoma. Spine J 14:2946–2953. doi: 10.1016/j.spinee.2014.06.001 CrossRefPubMedGoogle Scholar
  28. 28.
    Liang TZ, Wan Y, Long GH, Zou XN, Peng XS, Zheng ZM (2010) Predictive value of three surgical scoring systems for estimation of life expectancy in patients with extradural spinal metastasis. Zhonghua Zhong Liu Za Zhi 32:875–879PubMedGoogle Scholar
  29. 29.
    Tokuhashi Y, Ajiro Y, Umezawa N (2009) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34:69–73. doi: 10.1097/BRS.0b013e3181913f19 CrossRefPubMedGoogle Scholar
  30. 30.
    Jaeschke R, Guyatt GH, Sackett DL (1994) Users’ guides to the medical literature. III. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? The evidence-based medicine working group. JAMA 271:703–707CrossRefPubMedGoogle Scholar
  31. 31.
    Fan J, Upadhye S, Worster A (2006) Understanding receiver operating characteristic (ROC) curves. CJEM 8:19–20PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Chang-Hyun Lee
    • 1
  • Chun Kee Chung
    • 2
  • Tae-Ahn Jahng
    • 3
  • Ki-jeong Kim
    • 3
  • Chi Heon Kim
    • 2
  • Seung-Jae Hyun
    • 3
  • Hyun-Jib Kim
    • 3
  • Sang Ryong Jeon
    • 4
  • Ung-Kyu Chang
    • 5
  • Sun-Ho Lee
    • 6
  • Seong-Hwan Moon
    • 7
  • Haroon Majeed
    • 8
  • Dan Zhang
    • 9
  • Gwenaelle Gravis
    • 10
  • Christine Wibmer
    • 11
  • Naresh Kumar
    • 12
  • Kyung Yun Moon
    • 13
  • Jin Hoon Park
    • 14
  • Emeline Tabouret
    • 10
    • 15
  • Stephane Fuentes
    • 16
  1. 1.Department of NeurosurgeryKonyang University HospitalDaejeonRepublic of Korea
  2. 2.Department of Neurosurgery, Seoul National University HospitalSeoul National University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Neurosurgery, Spine Center, Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamRepublic of Korea
  4. 4.Department of Neurological Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  5. 5.Department of Neurosurgery, Korea Cancer Center HospitalKorea Institute of Radiological and Medical ScienceSeoulRepublic of Korea
  6. 6.Department of Neurosurgery and Spine Center, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
  7. 7.Department of Orthopaedic SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  8. 8.Trauma and OrthopaedicsUniversity Hospital of North StaffordshireStoke-on-TrentUK
  9. 9.Spine Tumor Center, Changzheng HospitalSecond Military Medical UniversityShanghaiChina
  10. 10.Department of Medical OncologyInstitut Paoli CalmettesMarseilleFrance
  11. 11.Department of Orthopaedic SurgeryMedical University of GrazGrazAustria
  12. 12.Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery ClusterNational University HospitalSingaporeSingapore
  13. 13.Department of NeurosurgeryAnsan 21th Century HospitalAnsanRepublic of Korea
  14. 14.Department of Neurological SurgeryGangneung Asan HospitalGangneungRepublic of Korea
  15. 15.Aix-Marseille UniversityMarseilleFrance
  16. 16.Department of NeurosurgeryAPHM, Hopital de la TimoneMarseilleFrance

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