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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

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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.

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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).

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Konyang University Hospital, Daejeon, Republic of Korea

    Chang-Hyun Lee

  2. Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea

    Chun Kee Chung & Chi Heon Kim

  3. Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea

    Tae-Ahn Jahng, Ki-jeong Kim, Seung-Jae Hyun & Hyun-Jib Kim

  4. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Sang Ryong Jeon

  5. Department of Neurosurgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Science, Seoul, Republic of Korea

    Ung-Kyu Chang

  6. Department of Neurosurgery and Spine Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Sun-Ho Lee

  7. Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea

    Seong-Hwan Moon

  8. Trauma and Orthopaedics, University Hospital of North Staffordshire, Stoke-on-Trent, UK

    Haroon Majeed

  9. Spine Tumor Center, Changzheng Hospital, Second Military Medical University, Shanghai, China

    Dan Zhang

  10. Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France

    Gwenaelle Gravis & Emeline Tabouret

  11. Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria

    Christine Wibmer

  12. Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore

    Naresh Kumar

  13. Department of Neurosurgery, Ansan 21th Century Hospital, Ansan, Republic of Korea

    Kyung Yun Moon

  14. Department of Neurological Surgery, Gangneung Asan Hospital, Gangneung, Republic of Korea

    Jin Hoon Park

  15. Aix-Marseille University, Marseille, France

    Emeline Tabouret

  16. Department of Neurosurgery, APHM, Hopital de la Timone, Marseille, France

    Stephane Fuentes

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  1. Chang-Hyun Lee
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  2. Chun Kee Chung
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  13. Dan Zhang
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  14. Gwenaelle Gravis
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  16. Naresh Kumar
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  20. Stephane Fuentes
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Corresponding author

Correspondence to Chun Kee Chung.

Electronic supplementary material

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11060_2015_1794_MOESM1_ESM.tif

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

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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Lee, CH., Chung, C.K., Jahng, TA. et al. 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. J Neurooncol 123, 267–275 (2015). https://doi.org/10.1007/s11060-015-1794-1

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