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

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Abstract

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.

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Conflict of interest

RJP, SMS, JR, PLZ, RSE, MLG, and JPW have no disclosures. CRG is a UNCF Merck Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund. AB is the recipient of a research grant from DePuy Spine and serves on the clinical advisory board of MedImmune, LLC. TW is a recipient of a research grant from Eli Lilly and Company. ZG has disclosures of stock ownership in US Spine and Spinal Kinetics, consulting, speaking and teaching for the AO Foundation and Research support from Depuy, NREF, AOSpine and AO North America. DS is a consultant for DePuy, Medtronic, Nuvasive, and Globus. The authors report no external source of funding. The corresponding author had full access to all data in this study and has final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 7-109, Baltimore, MD, 21287, USA

    Jay Rhee, C. Rory Goodwin, Patricia L. Zadnik, Rachel Sarabia-Estrada, Mari L. Groves, Ali Bydon, Timothy F. Witham, Jean-Paul Wolinsky, Ziya L. Gokaslan & Daniel M. Sciubba

  2. Department of Neurosurgery, Georgetown University Hospital, 3800 Reservoir Road NW, PHC-7, Washington, DC, 20007, USA

    Rory J. Petteys & Steven M. Spitz

Authors
  1. Rory J. Petteys
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  2. Steven M. Spitz
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  3. Jay Rhee
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  4. C. Rory Goodwin
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  5. Patricia L. Zadnik
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  6. Rachel Sarabia-Estrada
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  11. Ziya L. Gokaslan
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  12. Daniel M. Sciubba
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Correspondence to Rory J. Petteys.

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Petteys, R.J., Spitz, S.M., Rhee, J. et al. Tokuhashi score is predictive of survival in a cohort of patients undergoing surgery for renal cell carcinoma spinal metastases. Eur Spine J 24, 2142–2149 (2015). https://doi.org/10.1007/s00586-015-3862-9

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  • DOI: https://doi.org/10.1007/s00586-015-3862-9

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