DOS Kongressen 2014 ·
167
Moderate Precision of the Tokuhashi Revised Score
and the Bauer Modified Score in Patients with
Metastatic Spinal Cord Compression.
Søren Schmidt Morgen, Martin Gehrchen, Dennis Hallager Nielsen,
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:
Estimated survival is an important element in the evaluation
of patients with metastatic spinal cord compression (MSCC). The Tokuhashi
Revised score (TR) has been recommended as a prognostic score in many stud-
ies, but two recent studies have showed that the Bauer Modified Score (BM)
was the more accurate.
Purpose / Aim of Study:
To compare the TR and the BM in the prediction of
survival among patients surgically treated for MSCC.
Materials and Methods:
From January 1st 2009 to December 31st 2011,
a total of 246 MSCC patients were treated surgically for MSCC in one center.
These patients were included in a cohort with a minimum of two years follow-
up. The patients were scored with the TR and the BM scoring systems.
Findings / Results:
The mean age on admission was 63 years (range 27-94)
and 54% of the patients were men. The most common primary tumor-sites
were lungs (24%) and breast (15%). The logrank test showed that each prog-
nostic group in both scoring system were significantly different (p < 0.001). The
Kaplan Meyer survival curves showed good prognostic value in each prognostic
group for both of the scoring systems, but the specificity and sensitivity was
moderate. In both scoring systems the prognostic groups with a short predicted
survival had “longtime survivors” who lived longer than one-year (20% in the
TR-group and 19% in the BM- group). For the prognostic groups with long es-
timated survival, a considerable proportion of the patients were dead within 6
months (27% in the BM and 31% in the TR).
Conclusions:
This study showed that the TR and the BM ability to predict sur-
vival were almost equal. Both scoring systems performed well in categorizing
patients in prognostic groups, but the moderate precision in predicting survival
emphasizes that a modification may be necessary.
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