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· DOS Abstracts
A modification of the Tokuhashi Revised score
improves prognostic precision in patients with
metastatic spinal cord compression.
Søren Schmidt Morgen, Martin Gehrchen, Sebastian Bjørck, Claus Falck Larsen,
Svend Aage Engelholm, Benny Dahl
Spine Section, Department of Orthopedic Surgery , Copenhagen University
Hospital, Rigshospitalet ; Trauma Center, Copenhagen University Hospital,
Rigshospitalet ; Department of Radiation and Oncology, Copenhagen
University Hospital, Rigshospitalet
Background:
Patients suffering from metastatic spinal cord compression
(MSCC) are routinely evaluated with pre-operative prognostic scoring systems.
The most well known scoring system is the Tokuhashi Revised score (TR), but
recent studies have proposed a modification of the TR due to lack of precision.
Purpose / Aim of Study:
To modify the TR in order to improve the prognostic
precision.
Materials and Methods:
In 2011 and 2012 a total of 1143 consecutive pa-
tients admitted with MSCC were prospectively included and variables for the
TR score were collected. In the 2011 cohort each component of the TR in-
cluding primary cancer diagnosis was analyzed regarding prognostic ability by
Cox regression analysis. Based on these findings a modified TR score (MTR) was
defined. New prognostic groups were determined using Receiver Operating
Characteristics (ROC) analysis for survival < 6 months, >= 6 months, and >=
12 months. These prognostic groups were used to compare the TR and the
MTR in the 2012 cohort based on Kaplan-Meier (KM) survival curves and ROC
analysis.
Findings / Results:
There were no significant differences between the 2011
and the 2012 cohort regarding age and gender distribution. The mean age was
66 years (range 20-97) and the most common primary tumor sites were pros-
tate (21%) and lung (20%). In the 2012 cohort the KM curves showed that
the actual survival for each prognostic group was separated more accurate with
the MTR compared to the TR. The areas under the ROC curves were significant
larger for the MTR compared with the TR. The ROC area were for < 6 months
survival, MTR = 0.71 and TR = 0.65; p = 0.003, for >= 6 months survival, MTR
= 0.71 and TR = 0.65; p = 0.003, for >= 12 months survival MTR = 0.72 and
TR= 0.67; p = 0.0015.
Conclusions:
A modification of the TR can improve the precision in the estima-
tion of survival among patients with MSCC.
109.
