title: Evaluation of scoring systems and prognostic factors in patients with spinal metastases from nasopharyngeal carcinoma.
abstract: BACKGROUND
  The decision for operative treatment of patients with spinal metastases is dependent on the patient's predicted survival. Tokuhashi, Tomita, Bauer, and Oswestry scores have been devised for survival prediction; however, none of these systems have been evaluated in nasopharyngeal carcinoma (NPC).
  
  
  OBJECTIVE
  To investigate the accuracy of these scoring systems in predicting survival and to identify prognostic factors for survival of the patients with spinal metastases from NPC.
  
  
  METHODS
  Retrospective analysis of the patients with spinal metastases from NPC who were treated in our institution.
  
  
  METHODS
  The study included 87 patients with spinal metastases from NPC.
  
  
  METHODS
  The primary outcome measure was the survival time of these patients. The potential prognostic factors that are known to influence survival such as general condition, extraspinal bone metastases, vertebral bone metastases, visceral metastases, and neurologic assessment based on Frankel score were also studied.
  
  
  METHODS
  The predicted survival according to the four scoring systems were calculated and labeled as "A" scores. These patients were then rescored by assigning NPC as a good prognostic tumor and labeled as "B" scores. The predicted survival of scores A and B were compared with actual survival. Potential prognostic factors of survival were investigated using univariate and multivariate Cox regression analyses. For all scoring systems, Kaplan-Meier survival estimates and log-rank tests were done; the predictive values were calculated using postestimation after Cox regression analyses.
  
  
  RESULTS
  The median overall survival for the whole cohort was 13 (range 1-120) months. In multivariate analysis, general condition (p<.01), visceral metastases (p<.01), and vertebral metastases (p<.01) showed significant association with survival. The absolute score of all scoring systems was significantly associated with actual survival, which extended to the different prognostic subgroups of each scoring systems. Log-rank test revealed significant differences in survival between the different prognostic subgroups of all scoring systems (p<.01). Predictive value of survival by modified Tokuhashi score was the highest among all four scoring systems.
  
  
  CONCLUSIONS
  Patients with spinal metastases from NPC have relatively good survival prognosis. All four scoring systems could be used to prognosticate these patients. The modified Tokuhashi score is the best in doing so.
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228. Electronic address: dosksn@nus.edu.sg.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228.
authors.forename: Jonathan J H
authors.initials: JJ
authors.lastname: Tan
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228.
authors.forename: Aye S
authors.initials: AS
authors.lastname: Zaw
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228.
authors.forename: Joel L
authors.initials: JL
authors.lastname: Lim
authors.affiliation: Dean's Office Medicine, Investigational Medicine Unit, National University of Singapore, MD3, 8 Medical Drive, Singapore 117597.
authors.forename: Khin L
authors.initials: KL
authors.lastname: Wai
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228.
authors.forename: Rishi
authors.initials: R
authors.lastname: Malhotra
authors.affiliation: Department of Otolaryngology, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Singapore 119228.
authors.forename: Thomas K S
authors.initials: TK
authors.lastname: Loh
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228.
authors.forename: Gabriel K P
authors.initials: GK
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block, Level 11, Singapore 119228.
authors.forename: Joseph
authors.initials: J
authors.lastname: Thambiah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011379:Prognosis; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000175:diagnosis* / Q000556:secondary
keywords: Bauer; Nasopharyngeal carcinoma; Oswestry; Spinal metastasis; Tokuhashi; Tomita