Vertebral metastases - A critical appreciation of the preoperative prognostic Tokuhashi score in a series of 71 cases

Study Design. The utility of the Tokuhashi score was assessed in a retrospective study in 71 patients with vertebral metastases. Objectives. To study the importance of the site of the primary tumor as a parameter in the preoperative prognostic Tokuhashi score. Summary of Background Data. A preoperative score composed of six parameters, each rated from zero to two, has been proposed by Tokuhashi for the prognostic assessment of patients with metastases to the spine. Methods. Seventy-one patients with vertebral metastases were studied. There were 34 cases of thyroid cancer metastases, 28 cases of renal cancer metastases, and nine cases of metastases of unknown origin. In each patient, a local and a systemic tumor search were performed. Patients were divided into groups based on the primary site of the tumor, and each group was analyzed separately. Results. In cases of vertebral metastases of thyroid cancers, surgery to excise single metastases was found to provide good results, as was palliative surgery of multiple metastases. Vertebral metastases of renal tumors were rarely single, and the results of palliative surgery were less satisfactory. Vertebral metastases of unknown primary tumors had a poor outcome, regardless of whether surgery was excisional or palliative. The median survival period in patients with metastases of unknown primary tumors was significantly shorter than that in patients with renal or thyroid cancer metastases. Conclusion. The Tokuhashi preoperative score is successful as a prognostic tool. However, it attributes the same one-point rating to metastases of renal cancer and to those of unknown primary tumors. In the case of metastases of unknown primary tumors, this rating is too high and should be reduced to 0.