Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Spine (Phila Pa 1976). 2011 May 15;36(11):910-7. doi: 10.1097/BRS.0b013e3181e56ec1.
Prospective observational cohort study.
To define the utility of the revised Tokuhashi score in relation to predicting survival in patients with spinal metastases regardless of the treatment pathway.
The revised Tokuhashi score has been used for the prediction of survival. In this scoring system, however, all the patients were sourced by orthopedic surgeons, and asymptomatic patients were excluded. That might present a significant source of patient selection bias. The treatment plan was also affected by the predicted survival in their system.
All patients within 2 years of diagnosis of spinal metastases, whether symptomatic were recruited. Minimum 1-year follow-up was required. During the study period, a total of 85 patients were analyzed including 44 patients who died within 1 year. The relation between the revised Tokuhashi score and survival were analyzed using the Cox proportional hazard model and Spearman's rank correlation coefficient.
The mean age was 60.3 years (range: 35-84) and the median survival was 11.6 months. On multivariate analysis, lower performance status (Karnofsky performance status, 50%-70%) and unresectable organ metastases were significantly associated with poor survival, with hazard ratios of 2.92 and 4.44, respectively. In primary cancer type, lung and kidney cancer were also significantly associated with poor survival, with hazard ratios of 4.25 and 2.60, respectively. The revised Tokuhashi score groups were significantly correlated with the survival groups (ρ = 0.530, P < 0.001). In 67 (79%) of 85 patients, actual survival matched the predicted survival.
Lower score on performance status, the existence of organ metastases, and primary cancer of the lung and the kidney were significantly associated with poor survival. The revised Tokuhashi score was found to be very useful to predict survival regardless of the treatment pathway. In most patients, actual survival matched their predicted survival.
前瞻性观察队列研究。
确定修订后的 Tokuhashi 评分在预测脊柱转移患者生存方面的效用，无论治疗途径如何。
修订后的 Tokuhashi 评分已用于预测生存。然而，在这个评分系统中，所有患者均由骨科医生提供，且排除了无症状患者。这可能是一个显著的患者选择偏倚来源。他们的系统中的预测生存也会影响治疗计划。
所有在诊断为脊柱转移后 2 年内的患者，无论是否有症状，均被招募。需要至少 1 年的随访。在研究期间，共分析了 85 例患者，其中 44 例患者在 1 年内死亡。使用 Cox 比例风险模型和 Spearman 秩相关系数分析修订后的 Tokuhashi 评分与生存之间的关系。
平均年龄为 60.3 岁（范围：35-84 岁），中位生存期为 11.6 个月。多变量分析显示，较低的功能状态（卡诺夫斯基功能状态，50%-70%）和不可切除的器官转移与较差的生存显著相关，风险比分别为 2.92 和 4.44。在原发癌类型中，肺癌和肾癌也与较差的生存显著相关，风险比分别为 4.25 和 2.60。修订后的 Tokuhashi 评分组与生存组显著相关（ρ=0.530，P<0.001）。在 85 例患者中的 67 例（79%）中，实际生存与预测生存相匹配。
功能状态评分较低、存在器官转移以及肺部和肾脏的原发癌与较差的生存显著相关。修订后的 Tokuhashi 评分被发现非常有助于预测生存，无论治疗途径如何。在大多数患者中，实际生存与预测生存相匹配。
