Tokuhashi score is predictive of survival in a cohort of patients undergoing surgery for renal cell carcinoma spinal metastases

• Published in: European spine journal Vol. 24; no. 10; pp. 2142 - 2149
• Main Authors: Petteys, Rory J., Spitz, Steven M., Rhee, Jay, Rory Goodwin, C., Zadnik, Patricia L., Sarabia-Estrada, Rachel, Groves, Mari L., Bydon, Ali, Witham, Timothy F., Wolinsky, Jean-Paul, Gokaslan, Ziya L., Sciubba, Daniel M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2015; Springer Nature B.V
• Subjects: Adult; Aged; Carcinoma, Renal Cell - diagnosis; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Cohort Studies; Female; Humans; Kaplan-Meier Estimate; Life Expectancy; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Neurosurgical Procedures - methods; Original Article; Prognosis; Retrospective Studies; Severity of Illness Index; Spinal Neoplasms - diagnosis; Spinal Neoplasms - secondary; Spinal Neoplasms - surgery; Surgical Orthopedics; Tomography, X-Ray Computed; Metastatic; Renal cell carcinoma; Spine; Surgery; Tokuhashi score
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-015-3862-9

Purpose
Renal cell carcinoma (RCC) is an aggressive disease that metastasizes to the spine often requiring surgery. However, selecting the appropriate surgical intervention can be challenging. The Tokuhashi scoring system can be used to predict survival and inform the surgical strategy. We set out to determine the Tokuhashi score for patients with RCC spine metastases and compare expected and observed survival.
Methods
Records were reviewed for all patients who underwent surgery for spinal metastases at a single institution from January 2000 to December 2011 to determine the Tokuhashi score and survival. Kaplan–Meier estimates and log-rank test for univariate analysis were performed with R version 2.15.12 (R Foundation, 2012).
Results
Thirty patients underwent 40 spinal operations for metastatic RCC. Median survival was 11.4 months. Preoperative Tokuhashi scores were: 12–15, 15 patients; 9–11, seven patients; 0–8, eight patients. Median survival was 32.9, 11.7, and 5.4 months, respectively. Bone (
p
 = 0.01) and visceral metastases (
p
 = 0.005), and KPS (
p
 = 0.002) significantly affected survival. Tokuhashi score predicted survival (
p
 = 0.016); survival differed between the high and low score groups (
p
 = 0.006).
Conclusions
RCC is an aggressive disease with short life expectancy when metastatic to the spine. However, patients with low systemic disease burden and solitary spinal metastases can have long survival and benefit from excisional surgery. Tokuhashi score can be useful in selecting surgical intervention in patients with RCC spinal metastases, and may be more relevant than in other cancers with spinal metastases.