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 ChungEmail author
  • 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


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.


Meta-analysis Metastasis Spine Tokuhashi Tomita Survival Prognosis 


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)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Chang-Hyun Lee
    • 1
  • Chun Kee Chung
    • 2
    Email author
  • 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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