Abstract
Purpose
Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced.
Methods
A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival.
Results
Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00 %; for patients expected to survive less than 6 months (group I), it was 64.10 %; 6–12 months (group II), 55.32 %; and more than 12 months (group III), 77.21 %. A progressive decrease in accuracy over time was statistically significant in groups I and II.
Conclusions
The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.
Similar content being viewed by others
References
Delank KS, Wendtner C, Eich HT, Eysel P (2011) The treatment of spinal metastases. Dtsch Arzt Int 108:71–270
Bartels RHMA, van der Linden YM, van der Graaf WTA (2008) Spinal extradural metastasis: review of current treatment options. CA Cancer J Clinicians 58:245–259
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(19):2186–2191
Gerszten PC, Mendel E, Yamada Y (2009) Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes? Spine 34(22):S78–S92
Kim CH, Chung CK, Sohn S, Lee S, Park SB (2013) Less invasive palliative surgery for spinal metastases. J Surg Oncol 108(7):499–503
Schroeder JE, Ecker E, Skelly AC, Kaplan L (2011) Cement augmentation in spinal tumors: a systematic review comparing vertebroplasty and kyphoplasty. Evid Based Spine Care J 2(4):35–43
Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15(11):1110–1113
Enkaoua EA, Doursounian L, Chatellier G, Mabesoone F, Aimard T, Saillant G (1997) Vertebral metastases: a critical appreciation of the preoperative prognostic tokuhashi score in a series of 71 cases. Spine 22(19):2293–2298
Tomita K, Kawahara N, Kobayashi T, Yosihida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 3:298–305
Masi G, Vasile E, Loupakis F, Cupini S, Fornaro L, Baldi G, Salvatore L, Cremolini C, Stasi I, Brunetti I, Fabbri MA, Puglisi M, Trenta P, Granetto C, Chiara S, Fioretto L, Allegrini G, Crinò L, Andreuccetti M, Falcone A (2011) Randomized trial of two induction chemotherapy regimens in metastatic colorectal cancer: an updated analysis. J Natl Cancer Inst 103(1):21–30
Balduzzi S, Mantarro S, Guarneri V, Tagliabue L, Pistotti V, Moja L, D’Amico R (2014) Trastuzumab-containing regimens for metastatic breast cancer. Cochrane Database Syst Rev 6:CD006242
Bland JM, Altman DG (2003) Applying the right statistics: analyses of measurement studies. Ultrasound Obstet Gynecol 22(1):85–93
Tokuhashi Y, Ajiro Y, Umezawa N (2009) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34(1):69–73
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. Eur J Surg Oncol 33(7):914–919
Mollahoseini R, Farhan F, Khajoo A, Jouibari MA, Gholipour F (2011) Is Tokuhashi score suitable for evaluation of life expectancy before surgery in Iranian patients with spinal metastases? J Res Med Sci 16(9):1183–1188
Pointillart V, Vital JM, Salmi R, Diallo A, Quan GM (2011) Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137(5):849–856
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(11):910–917
Hernandez-Fernandez A, Vélez R, Lersundi-Artamendi A, Pellisé F (2012) External validity of the Tokuhashi score in patients with vertebral metastasis. J Cancer Res Clin Oncol 138(9):1493–1500
Quraishi NA, Manoharan SR, Arealis G, Khurana A, Elsayed S, Edwards KL, Boszczyk BM (2013) Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Eur Spine J 22(Suppl 1):S21–S26
Wang M, Bünger CE, Li H, Wu C, Høy K, Niedermann B, Helmig P, Wang Y, Jensen AB, Schättiger 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(7):573–582
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(3):565–568
Tabouret E, Cauvin C, Fuentes S, Esterni B, Adetchessi T, Salem N, Madroszyk A, Gonçalves A, Casalonga F, Gravis G (2013) Reassessment of scoring systems and prognostic factors for metastatic spinal cord compression. Spine J. doi:10.1016/j.spinee.2013.06.036
Dutch Bone Metastasis Study Group, van der Linden YM, Dijkstra SP, Vonk EJ, Marijnen CA, Leer JW (2005) Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer 103(2):320–328
Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17(11):1488–1495. doi:10.1007/s00586-008-0763-1
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(23):1977–1986
Hessler C, Vettorazzi E, Madert J, Bokemeyer C, Panse J (2011) Actual and predicted survival time of patients with spinal metastases of lung cancer: evaluation of the robustness of the Tokuhashi score. Spine 36(12):983–989
Acknowledgments
In memory of Edward A. Meister, PhD.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare the absence of any conflict of interest or financial relationships pertaining to this manuscript.
Rights and permissions
About this article
Cite this article
Zoccali, C., Skoch, J., Walter, C.M. et al. The Tokuhashi score: effectiveness and pitfalls. Eur Spine J 25, 673–678 (2016). https://doi.org/10.1007/s00586-015-4339-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-4339-6