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Actual and Predicted Survival Time of Patients With Spinal Metastases of Lung Cancer: Evaluation of the Robustness of the Tokuhashi Score

Hessler, Christian, MD*; Vettorazzi, Eik, MSc; Madert, Juergen, MD; Bokemeyer, Carsten, MD§; Panse, Jens, MD

doi: 10.1097/BRS.0b013e3181e8f7f8
Health Services Research

Study Design. In a retrospective analysis we evaluated the achieved and the predicted survival times according to the Tokuhashi score for patients with spinal metastases of lung cancer (lc).

Objective. Our aim was to investigate the robustness of the Tokuhashi Score for this group of patients.

Summary of Background Data. The decision on operative versus conservative treatment for cancer patients with vertebral metastases depend on their predicted lifespan. Although the score of Tokuhashi is commonly used for prognostic predictions, it's reliability for specific tumor types (e.g., lc), has not been validated.

Methods. Seventy-six patients who had undergone spinal surgery for lc metastases between 1999 and 2004 were verified according to the Tokuhashi score and predicted versus achieved survival times were compared.

Results. The median overall survival (OS) after surgery for all patients was 108 (3–1767) days (102 [5–1767] days for patients with NSCLC [n = 49; 64.5%] and 108 [3–473] days for patients with SCLC [n = 24; 31.6%]). Survival times differed depending on the time period of procedure performance (OS 81 [3–435] days for patients operated between 1999 and 2001 [n = 38], 135 [8–1767] days for patients who received surgery between 2002 and 2004 [n = 38]). Actual and predicted survival were similar in 51 of 76 cases (67.1%), while there was no correlation in 25 of 76 (32.9%) cases. Results were comparable for all histologic subgroups.

Conclusion. Although the survival time of patients with vertebral metastases from lc has increased over the last 10 years, the overall outcome is still poor. For the prediction of an individual prognosis in the group of lc patients the score of Tokuhashi seems to be a suboptimal tool. We conclude that therapeutic decisions for such patients should be made based on interdisciplinary platforms, especially in the light of improved systemic treatment options.

We compared the predicted (Tokuhashi score) versus achieved survival times of 76 patients after spinal surgery for lung cancer (lc) metastases. Therapeutic decisions for these patients should be made based on interdisciplinary platforms. The Tokuhashi Score appears to be a suboptimal tool for patients who suffers from lc.

*Department of Neurosurgery, Medical Center Hamburg-Eppendorf, Germany

Department of Medical Biometry and Epidemiology, Medical Center Hamburg-Eppendorf, Germany

Department of Traumatology, General Hospital St. Georg, Hamburg, Germany

§Department of Oncology/Hematology with section Pneumonology, Hubertus-Wald Tumorzentrum (University Cancer Center Hamburg), University Medical Center Hamburg-Eppendorf, Germany.

Address correspondence and reprint requests to Christian Hessler, MD, University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Martinistrasse 52, 20246 Hamburg, Germany, E-mail:

Acknowledgement date: December 23, 2009. Revised date: March 4, 2010. Accepted date: May 3, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.