A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis

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Abstract

Background

The prognosis of patients with spinal metastasis is not very promising and hard to predict. It is for this reason that scoring systems, such as the modified Tokuhashi and Tomita scores, have been created. We sought to determine the effectiveness of these scores in predicting patient survival.

Methods

We retrospectively reviewed the data of all patients treated for spinal metastasis between March 2003 and March 2012 in our centre. We computed the Tokuhashi and Tomita scores and compared them with documented patient survival. The 2 scores were also compared with one another.

Results

We identified 128 patients with spinal metastasis. The average survival of patients with predicted poor, average and good prognosis was 5, 17 and 25 months, respectively for the modified Tokuhashi score and 3, 16 and 19 months, respectively, for the Tomita score. Poor, average and good prognosis predictions differed significantly from one another for all 3 categories for the Tokuhashi score (all p < 0.05). There was no significant difference in the moderate and good prognoses for the Tomita score (p = 0.15). When comparing both scores, we obtained a weighted κ of 0.4489 (standard deviation 0.0568, 95% confidence interval 0.3376–0.5602), demonstrating moderate agreement between scores.

Conclusion

Both scores have merit for use in a clinical setting and can be used as tools to help determine treatment choice. The modified Tokuhashi score had better accuracy in determining actual survival.

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