Modified score based on revised Tokuhashi score is needed for the determination of surgical intervention in patients with lung cancer metastases to the spine

• Published in: World journal of surgical oncology Vol. 17; no. 1; p. 194
• Main Authors: Cai, Zhenyu, Tang, Xiaodong, Yang, Rongli, Yan, Taiqiang, Guo, Wei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.11.2019; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Area Under Curve; Cancer metastasis; Cancer patients; Cancer research; Care and treatment; Female; Follow-Up Studies; Humans; Lung cancer; Lung cancer metastases to the spine; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical research; Middle Aged; Modified score; Neurosurgical Procedures - methods; Palliative care; Predicting survival; Prognosis; Proportional Hazards Models; Prospective Studies; Retrospective Studies; Severity of Illness Index; Spinal Neoplasms - secondary; Spinal Neoplasms - surgery; Surgery; Surgical intervention; Survival Rate; Targeted therapy; Tumor marker; Tumor markers; Tumors; Tumor marker; Lung cancer metastases to the spine; Predicting survival; Modified score; Targeted therapy; Surgical intervention
• ISSN: 1477-7819; 1477-7819
• DOI: 10.1186/s12957-019-1738-x

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. Our 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. Targeted 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. The modified RTS has improved prognostic accuracy in patients with lung cancer metastases to the spine.