Prognostic scoring systems reflect the prognosis of patients with metastatic spinal tumors who underwent spinal surgery in recent cases: JASA multicenter prospective study.

Abstract

The incidence of cancer and related deaths has increased substantially, with bone commonly serving as a metastatic site. Metastatic spinal tumors severely impair quality of life and activities of daily living. Prognostic scoring systems such as the revised Tokuhashi and Tomita scores are widely used in surgical decision-making for these tumors. However, their accuracy for recent cancer cases is unclear due to advances in cancer therapy. This multicenter, prospective study by the Japan Association of Spine Surgeons with Ambition analyzed 413 surgical cases for metastatic spinal tumors from October 2018 to March 2021. Of these, 272 cases with complete data were included. The Kaplan-Meier method, log-rank test, and statistical analysis were used to assess the association between survival and prognostic scores. Both the revised Tokuhashi and Tomita scores significantly stratified patients by survival (P < 0.01). The revised Tokuhashi score accurately predicted survival in 60.3 % of patients, underestimated it in 33.1 %, and overestimated it in 6.6 %. Significant score differences were found among groups with different survival durations. However, differentiating between <6-month and 6-12-month survival periods was difficult. The revised Tokuhashi and Tomita scores remain valid tools for predicting prognosis in patients undergoing surgery for metastatic spinal tumors. Nonetheless, these systems tend to underestimate survival in recent cases, particularly in short-term prognoses. Updating the scoring criteria may be necessary to reflect advancements in cancer therapy and extended patient survival.