The Tokuhashi score: effectiveness and pitfalls

Carmine Zoccali, Jesse Skoch, Christina M. Walter, Mohammad Torabi, Mark Borgstrom, Mhd-Ali - Baaj

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose: Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced. Methods: A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival. Results: Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00 %; for patients expected to survive less than 6 months (group I), it was 64.10 %; 6–12 months (group II), 55.32 %; and more than 12 months (group III), 77.21 %. A progressive decrease in accuracy over time was statistically significant in groups I and II. Conclusions: The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.

Original languageEnglish (US)
Pages (from-to)673-678
Number of pages6
JournalEuropean Spine Journal
Volume25
Issue number3
DOIs
StatePublished - Mar 1 2016

Fingerprint

Spine
Survival
Therapeutics
Neoplasm Metastasis
Neoplasms

Keywords

  • Spine metastasis
  • Spondilectomy
  • Survival estimation
  • Tokuhashi score
  • Vertebrectomy

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Zoccali, C., Skoch, J., Walter, C. M., Torabi, M., Borgstrom, M., & Baaj, M-A. . (2016). The Tokuhashi score: effectiveness and pitfalls. European Spine Journal, 25(3), 673-678. https://doi.org/10.1007/s00586-015-4339-6

The Tokuhashi score : effectiveness and pitfalls. / Zoccali, Carmine; Skoch, Jesse; Walter, Christina M.; Torabi, Mohammad; Borgstrom, Mark; Baaj, Mhd-Ali -.

In: European Spine Journal, Vol. 25, No. 3, 01.03.2016, p. 673-678.

Research output: Contribution to journalArticle

Zoccali, C, Skoch, J, Walter, CM, Torabi, M, Borgstrom, M & Baaj, M-A 2016, 'The Tokuhashi score: effectiveness and pitfalls', European Spine Journal, vol. 25, no. 3, pp. 673-678. https://doi.org/10.1007/s00586-015-4339-6
Zoccali C, Skoch J, Walter CM, Torabi M, Borgstrom M, Baaj M-A. The Tokuhashi score: effectiveness and pitfalls. European Spine Journal. 2016 Mar 1;25(3):673-678. https://doi.org/10.1007/s00586-015-4339-6
Zoccali, Carmine ; Skoch, Jesse ; Walter, Christina M. ; Torabi, Mohammad ; Borgstrom, Mark ; Baaj, Mhd-Ali -. / The Tokuhashi score : effectiveness and pitfalls. In: European Spine Journal. 2016 ; Vol. 25, No. 3. pp. 673-678.
@article{f6db77b3bf9d47928f773761c2491058,
title = "The Tokuhashi score: effectiveness and pitfalls",
abstract = "Purpose: Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced. Methods: A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival. Results: Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00 {\%}; for patients expected to survive less than 6 months (group I), it was 64.10 {\%}; 6–12 months (group II), 55.32 {\%}; and more than 12 months (group III), 77.21 {\%}. A progressive decrease in accuracy over time was statistically significant in groups I and II. Conclusions: The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.",
keywords = "Spine metastasis, Spondilectomy, Survival estimation, Tokuhashi score, Vertebrectomy",
author = "Carmine Zoccali and Jesse Skoch and Walter, {Christina M.} and Mohammad Torabi and Mark Borgstrom and Baaj, {Mhd-Ali -}",
year = "2016",
month = "3",
day = "1",
doi = "10.1007/s00586-015-4339-6",
language = "English (US)",
volume = "25",
pages = "673--678",
journal = "European Spine Journal",
issn = "0940-6719",
publisher = "Springer Verlag",
number = "3",

}

TY - JOUR

T1 - The Tokuhashi score

T2 - effectiveness and pitfalls

AU - Zoccali, Carmine

AU - Skoch, Jesse

AU - Walter, Christina M.

AU - Torabi, Mohammad

AU - Borgstrom, Mark

AU - Baaj, Mhd-Ali -

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Purpose: Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced. Methods: A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival. Results: Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00 %; for patients expected to survive less than 6 months (group I), it was 64.10 %; 6–12 months (group II), 55.32 %; and more than 12 months (group III), 77.21 %. A progressive decrease in accuracy over time was statistically significant in groups I and II. Conclusions: The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.

AB - Purpose: Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced. Methods: A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival. Results: Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00 %; for patients expected to survive less than 6 months (group I), it was 64.10 %; 6–12 months (group II), 55.32 %; and more than 12 months (group III), 77.21 %. A progressive decrease in accuracy over time was statistically significant in groups I and II. Conclusions: The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.

KW - Spine metastasis

KW - Spondilectomy

KW - Survival estimation

KW - Tokuhashi score

KW - Vertebrectomy

UR - http://www.scopus.com/inward/record.url?scp=84958747330&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84958747330&partnerID=8YFLogxK

U2 - 10.1007/s00586-015-4339-6

DO - 10.1007/s00586-015-4339-6

M3 - Article

C2 - 26626082

AN - SCOPUS:84958747330

VL - 25

SP - 673

EP - 678

JO - European Spine Journal

JF - European Spine Journal

SN - 0940-6719

IS - 3

ER -