title: Predictive value of Tokuhashi scoring systems in spinal metastases, focusing on various primary tumor groups: evaluation of 448 patients in the Aarhus spinal metastases database.
abstract: METHODS
  We conducted a prospective cohort study of 448 patients with spinal metastases from a variety of cancer groups.
  
  
  OBJECTIVE
  To determine the specific predictive value of the Tokuhashi scoring system (T12) and its revised version (T15) in spinal metastases of various primary tumors.
  
  
  BACKGROUND
  The life expectancy of patients with spinal metastases is one of the most important factors in selecting the treatment modality. Tokuhashi et al formulated a prognostic scoring system with a total sum of 12 points for preoperative prediction of life expectancy in 1990 and revised it in 2005 to a total sum of 15 points. There is a lack of knowledge about the specific predictive value of those scoring systems in patients with spinal metastases from a variety of cancer groups.
  
  
  METHODS
  We included 448 patients with vertebral metastases who underwent surgical treatment during November 1992 to November 2009 in Aarhus University Hospital NBG. Data were retrieved from Aarhus Metastases Database. Scores based on T12 and T15 were calculated prospectively for each patient. We divided all the patients into different groups dictated by the site of their primary tumor. Predictive value and accuracy rate of the 2 scoring systems were compared in each cancer group.
  
  
  RESULTS
  Both the T12 and T15 scoring systems showed statistically significant predictive value when the 448 patients were analyzed in total (T12, P < 0.0001; T15, P < 0.0001). The accuracy rate was significantly higher in T15 (P < 0.0001) than in T12. The further analyses by primary cancer groups showed that the predictive value of T12 and T15 was primarily determined by the prostate (P = 0.0003) and breast group (P = 0.0385). Only T12 displayed predictive value in the colon group (P = 0.0011). Neither of the scoring systems showed significant predictive value in the lung (P > 0.05), renal (P > 0.05), or miscellaneous primary tumor groups (P > 0.05). The accuracy rate of prognosis in T15 was significantly improved in the prostate (P = 0.0032) and breast group (P < 0.0001).
  
  
  CONCLUSIONS
  Both T12 and T15 showed significant predictive value in patients with spinal metastases. T15 has a statistically higher accuracy rate than T12. Among the various cancer groups, the 2 scoring systems are especially reliable in prostate and breast metastases groups. T15 is recommended as superior to T12 because of its higher accuracy rate.
authors.affiliation: Department of Orthopaedic E, Aarhus University Hospital NBG, Aarhus, Denmark. wangmiaohello@hotmail.com
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.forename: Cody Eric
authors.initials: CE
authors.lastname: Bünger
authors.forename: Haisheng
authors.initials: H
authors.lastname: Li
authors.forename: Chunsen
authors.initials: C
authors.lastname: Wu
authors.forename: Kristian
authors.initials: K
authors.lastname: Høy
authors.forename: Bent
authors.initials: B
authors.lastname: Niedermann
authors.forename: Peter
authors.initials: P
authors.lastname: Helmig
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Anders Bonde
authors.initials: AB
authors.lastname: Jensen
authors.forename: Katrin
authors.initials: K
authors.lastname: Schättiger
authors.forename: Ebbe Stender
authors.initials: ES
authors.lastname: Hansen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000401:mortality / Q000556:secondary*; D013131:Spine / Q000473:pathology*; D015996:Survival Rate