Liang Tang-zhao, Wan Yong, Long Guang-hua, Zou Xue-nong, Peng Xin-sheng, Zheng Zhao-min
Department of Spine Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Zhong Liu Za Zhi. 2010 Nov;32(11):875-9.
To evaluate the predictive values of Tokuhashi score, revised Tokuhashi score and Tomita score systems for life expectancy and treatment options in patients with spinal metastasis.
From February 1996 to January 2009, spinal operations in 104 cases with spinal metastasis were performed in our hospital. There were 65 males and 39 females, with an average of 53.4 years (median 52.5 years). To calculate AUC (area under the curve) values of Receiver Operating Characteristic (ROC) curves of three scores, and to analyze the accuracy of prediction of life expectancy. To compare the actual survival time with the expected survival time of the three scores by Kaplan-Meier method. Spearman correlation analysis was performed between the survival time and three scoring systems.
All cases were followed-up with an average duration of 10.9 months, and 77 patients died. AUC analysis of ROC curves showed that the difference of the accuracy of the three scores was not significant. AUC in all groups of Tokuhashi Score was low, with a poor diagnostic accuracy. In the "died within 3 months" and "died within 6 months" groups of revised Tokuhashi score, the accuracy was low, while high in the other two groups. The AUC values of Tomita score in "died within 6 months" and "died within 24 months" were high, with a great diagnostic accuracy while the other two groups were low with a low diagnostic accuracy. Kaplan-Meier survival curve analysis showed that the actual survival time in all three scores was not entirely consistent with the expected survival time. Tokuhashi score and revised score were positively correlated with the survival time while that of Tomita score was negative.
All the three prognosis scores in patients with spinal metastasis were closely related with survival time. The combination of Tokuhashi score and Tomita score may be applied to better predict postoperative survival prognosis and guide the surgical options for patients with spinal metastasis.
评估Tokuhashi评分、修订的Tokuhashi评分和Tomita评分系统对脊柱转移瘤患者预期寿命及治疗选择的预测价值。
1996年2月至2009年1月，我院对104例脊柱转移瘤患者进行了脊柱手术。其中男性65例，女性39例，平均年龄53.4岁（中位数52.5岁）。计算三个评分系统的受试者操作特征（ROC）曲线的曲线下面积（AUC）值，分析预期寿命预测的准确性。采用Kaplan-Meier法比较三个评分系统的实际生存时间与预期生存时间。对生存时间与三个评分系统进行Spearman相关性分析。
所有病例均获随访，平均随访时间为10.9个月，77例患者死亡。ROC曲线的AUC分析显示，三个评分系统准确性的差异无统计学意义。Tokuhashi评分各分组的AUC均较低，诊断准确性较差。修订的Tokuhashi评分中“3个月内死亡”和“6个月内死亡”组的准确性较低，而其他两组较高。Tomita评分在“6个月内死亡”和“24个月内死亡”组的AUC值较高，诊断准确性高，而其他两组较低，诊断准确性低。Kaplan-Meier生存曲线分析显示，三个评分系统的实际生存时间与预期生存时间均不完全一致。Tokuhashi评分和修订评分与生存时间呈正相关，而Tomita评分与生存时间呈负相关。
脊柱转移瘤患者的三种预后评分均与生存时间密切相关。Tokuhashi评分与Tomita评分相结合可能有助于更好地预测脊柱转移瘤患者术后生存预后并指导手术选择。
