Lee Chang-Hyun, Chung Chun Kee, Jahng Tae-Ahn, Kim Ki-jeong, Kim Chi Heon, Hyun Seung-Jae, Kim Hyun-Jib, Jeon Sang Ryong, Chang Ung-Kyu, Lee Sun-Ho, Moon Seong-Hwan, Majeed Haroon, Zhang Dan, Gravis Gwenaelle, Wibmer Christine, Kumar Naresh, Moon Kyung Yun, Park Jin Hoon, Tabouret Emeline, Fuentes Stephane
Department of Neurosurgery, Konyang University Hospital, Daejeon, Republic of Korea.
J Neurooncol. 2015 Jun;123(2):267-75. doi: 10.1007/s11060-015-1794-1. Epub 2015 May 7.
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.
本研究旨在评估以6个月预测生存率作为手术治疗标准的德桥（Tokuhashi）评分和富田（Tomita）评分的诊断准确性。我们在PubMed、EMBASE、欧洲PubMed中心和Cochrane图书馆中检索了关于德桥评分和/或富田评分用于估计预测生存率的敏感性和特异性的论文。纳入基于先前研究，德桥评分截断值≥9且富田评分截断值≤7的研究。通过荟萃分析和个体参与者数据分析计算敏感性、特异性、诊断比值比（DOR）、曲线下面积（AUC）以及最佳截断值。最终，22项研究纳入荟萃分析，8项研究中的1095例患者纳入个体数据分析。在荟萃分析中，德桥评分预测6个月生存率的合并敏感性/特异性/DOR为57.7%/76.6%/4.70，富田评分为81.8%/47.8%/4.93。汇总的受试者工作特征曲线的AUC，德桥评分为0.748，富田评分为0.714。虽然德桥评分比富田评分略准确，但两者预测6个月残余生存率的准确性均较低。此外，预测6个月生存率时，德桥评分和富田评分的最佳截断值分别为8和6，而非9和7。仅使用德桥评分和富田评分来决定脊柱转移患者的手术，对6个月预测生存率的评估相当有限。德桥评分和富田评分可作为多学科方法的一部分，或者在多学科方法的背景下进行解读。
