CLINICAL CASE SERIES SPINE Volume 37, Number 7, pp 573–582 ©2012, Lippincott Williams & Wilkins Spine www.spinejournal.com 573 Predictive Value of Tokuhashi Scoring Systems in Spinal Metastases, Focusing on Various Primary Tumor Groups Evaluation of 448 Patients in the Aarhus Spinal Metastases Database Miao Wang, MD ,* Cody Eric Bünger, MD, DMSc,* Haisheng Li, MD,* Chunsen Wu, MD,† Kristian Høy, MD ,* Bent Niedermann, MD ,* Peter Helmig, MD ,* Yu Wang, MD,* Anders Bonde Jensen, MD,‡ Katrin Schättiger, MD,* and Ebbe Stender Hansen, MD, DMSc* Study Design. We conducted a prospective cohort study of 448 patients with spinal metastases from a variety of cancer groups. Objective. To determine the specific predictive value of the Tokuhashi scoring system (T12) and its revised version (T15) in spinal metastases of various primary tumors. Summary of Background Data. The life expectancy of patients with spinal metastases is one of the most important factors in selecting the treatment modality. Tokuhashi et al formulated a prognostic scoring system with a total sum of 12 points for preoperative prediction of life expectancy in 1990 and revised it in 2005 to a total sum of 15 points. There is a lack of knowledge about the specific predictive value of those scoring systems in patients with spinal metastases from a variety of cancer groups. Methods. We included 448 patients with vertebral metastases who underwent surgical treatment during November 1992 to November 2009 in Aarhus University Hospital NBG. Data were retrieved from Aarhus Metastases Database. Scores based on T12 and T15 were calculated prospectively for each patient. We divided all the patients into different groups dictated by the site of their primary tumor. Predictive value and accuracy rate of the 2 scoring systems were compared in each cancer group. Results. Both the T12 and T15 scoring systems showed statistically significant predictive value when the 448 patients were analyzed in total (T12, P < 0.0001; T15, P < 0.0001). The accuracy rate was S pinal metastases are the most common tumors involving the spine 1 ; the vertebral column is the most frequent site of skeletal metastases. 2 ,3 In the last 2 decades, the evolu- tion of surgical methods resulted in surgical treatments that produced increasingly better outcome, leading to improved postoperative quality of life. 4 However, high mortality contin- ues to be associated with major surgery of spinal metastases, and, therefore, surgical treatment must be considered care- fully in each patient. When choosing the optimal treatment, an important factor for the doctors is the ability to predict the prognosis 5 preoperatively. In 1990, Tokuhashi and colleagues proposed a trial assess- ment system for the preoperative evaluation of prognosis of patients with metastatic spine tumor on the basis of 64 sur- gically treated patients. The system was a point-cumulative- type scoring system with a total sum of 12 points, which was widely applied. There were 6 parameters in this evaluation system: (1) the general condition, (2) the number of extra spinal bone metastases, (3) the number of metastases in the From the *Department of Orthopaedic E, Aarhus University Hospital NBG, Aarhus, Denmark; †Department of Epidemiology, School of Public Health, Aarhus University, Aarhus, Denmark; and ‡Department of Oncology, Aarhus University Hospital NBG, Aarhus, Denmark. Acknowledgment date: March 22, 2011. Revision date: May 31, 2011. Acceptance date: June 13, 2011. The manuscript submitted does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Address correspondence and reprint requests to Miao Wang, MD, Department of Orthopaedic E, Aarhus University Hospital NBG, Århus Area, Denmark; E-mail: wangmiaohello@hotmail.com significantly higher in T15 ( P < 0.0001) than in T12. The further analyses by primary cancer groups showed that the predictive value of T12 and T15 was primarily determined by the prostate ( P = 0.0003) and breast group ( P = 0.0385). Only T12 displayed predictive value in the colon group ( P = 0.0011). Neither of the scoring systems showed significant predictive value in the lung ( P > 0.05), renal ( P > 0.05), or miscellaneous primary tumor groups ( P > 0.05). The accuracy rate of prognosis in T15 was significantly improved in the prostate ( P = 0.0032) and breast group ( P < 0.0001). Conclusion. Both T12 and T15 showed significant predictive value in patients with spinal metastases. T15 has a statistically higher accuracy rate than T12. Among the various cancer groups, the 2 scoring systems are especially reliable in prostate and breast metastases groups. T15 is recommended as superior to T12 because of its higher accuracy rate. Key words: Aarhus algorithm, life expectancy, primary tumor types, survival analysis, Tokuhashi 12 and 15 score, vertebral metastases. Spine 2012;37:573–582 DOI: 10.1097/BRS.0b013e31822bd6b0 Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.