A Study of the Predictive Value of the Modified Tokuhashi Score in Metastatic Spinal Tumour Causing Cord Compression in a Southern Chinese Population

IntroductionIt is generally agreed that operative intervention is beneficial in carefully selected groups of patients with metastatic spinal cord compression (MSCC). Tokuhashi et al have presented a preoperative scoring system to predict patient survival, which is widely used as a guideline for making a decision on whether to operate or not. However, only limited data are available regarding the validity of the Tokuhashi score in Southern Chinese populations.Materials and methodsWe report a series of 128 patients treated in our hospital from 2000 to 2010. All patients were diagnosed to have spinal metastasis of different origins with cord compression. Of the 128, 59 underwent operation and the remaining 69 received conservative treatments. The Tokuhashi score was then calculated retrospectively. The survival rate was analysed and p < 0.05 was considered statistically significant.ResultsIn our series, the accuracy of the modified Tokuhashi scoring for predicting the survival rate in patients with MSCC was demonstrated to be 79% (101/128). The poor prognostic group showed statistically significant worse survival than the two better prognostic groups. The type of primary cancer (p = 0.0015), visceral metastasis (p = 0.006), and the general condition (p < 0.001) were confirmed as significant survival prognostic factors. Nasopharyngeal carcinoma (NPC) had the most favourable outcome with a mean survival of 20.1 months.ConclusionThe modified Tokuhashi score was statistically correlated to the overall survival of MSCC patients in a Southern Chinese population. The type of primary cancer, visceral metastasis, and the general condition were statistically significant survival factors. We recommend weighting a higher score for NPC in the modified Tokuhashi scoring system in view of its favourable prognosis.

中文摘要目的脊柱手術對於部份惡性脊柱轉移瘤造成脊髓壓迫症的患者是有成效的。德橋醫生(Tokuhashi)提出了一個術前評分系統來預測病人的生存率，並於臨床廣泛應用以決定是否進行手術。然而，改良的德橋評分(modified Tokuhashi score)系統對於中國南方人是否有效，仍然缺乏數據支持。方法由2000至2010年間，我們對128名於本院治療的患者進行研究。所有患者均診斷為惡性脊柱轉移瘤脊髓壓迫症。其中59人進行手術冶療，其餘69人則給予保守治療。利用改良的德橋評分作回顧性分析其存活率並設定p值<0.05為有統計學有意義。結果79﹪的病人能透過改良的德橋評分準確地預測生存期。預後為不良的組別之生存率相對於其他兩個預後為較好的組別明顯較差。原發腫瘤的類型(p=0.0015)，內臟轉移(p=0.006)和身体狀況(p<0.001)被確認為重要的生存預測因素。鼻咽癌的存活率最佳，平均生存期為20.1個月。討論及結論改良的德橋評分能準確地預測惡性脊柱轉移瘤脊髓壓迫症患者的生存期。原發腫瘤的類型，內臟轉移和身体狀況為重要的生存預測因素。我們並建議給予鼻咽癌的惡性脊柱轉移瘤脊髓壓迫症的患者更高的分數以表達其較佳存活率。