Abstract
BackgroundRevised Tokuhashi score (RTS) is no longer accurate to predict the survival of patients with lung cancer metastases to the spine. This study is to identify additional prognostic factors in those patients, develop a modified prognostic score based on RTS, and verify the accuracy of the score in prediction.MethodsOur study included patients with lung cancer metastases to the spine who underwent surgery for spine metastasis. Potential prognostic factors were analyzed. Points were allocated for prognostic factors obtained from survival analyses. A modified score was developed by including prognostic factors and their points to RTS. Accuracy of the modified score was evaluated by comparing the coincidence between predicted and observed survival. Kaplan–Meier analysis and Cox regression models were used. Predictive values of scores for 6-month survival were measured via receiver operating characteristic (ROC) curves.ResultsTargeted therapy and tumor markers were additional independent prognostic factors. In the modified score, 2 and 1 points were allocated to the new evaluation factors. The points for factors based on RTS remained the same, and two prognostic groups were redefined. For group A patients who were predicted to live for less than 6 months, conservative procedures would be recommended. For group B patients who were predicted to live for 6 months or more, palliative surgery would be recommended. When comparing the modified score to RTS, the area under the receiver operating characteristic curve (AUCROC) and accuracy of score were improved.ConclusionsThe modified RTS has improved prognostic accuracy in patients with lung cancer metastases to the spine.
Highlights
The spine is a common site of bone metastases which cause metastatic spinal cord compression (MSCC) [1, 2]
This study aims to (1) identify additional prognostic factors of patients with lung cancer metastases to the spine, (2) develop a modified prognostic score based on Revised Tokuhashi score (RTS) which is specific for determining the surgical intervention of these patients, and (3) verify the accuracy of the modified score
In univariate Cox regression analysis, normal tumor markers of lung cancer, adoption of targeted therapy, and adoption of bisphosphonates increased the probability of good prognosis
Summary
The spine is a common site of bone metastases which cause metastatic spinal cord compression (MSCC) [1, 2]. Tokuhashi et al [3] indicated that RTS is accurate for patients with metastatic spine tumor and observed that the rate of consistency between prognostic and actual survival periods is 82.5%. Prognostic accuracy of RTS is controversial when it is utilized to evaluate the prognosis of patients with lung cancer metastases to the spine. RTS may be no longer accurate for predicting the survival of patients with lung cancer metastases to the spine. Revised Tokuhashi score (RTS) is no longer accurate to predict the survival of patients with lung cancer metastases to the spine. This study is to identify additional prognostic factors in those patients, develop a modified prognostic score based on RTS, and verify the accuracy of the score in prediction
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