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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Petteys, RJ; Spitz, SM; Rhee, J; Goodwin, CR; Zadnik, PL; Sarabia-Estrada, R; Groves, ML; Bydon, A; Witham, TF; Wolinsky, J-P; Gokaslan, ZL; Sciubba, DM

Published Date

  • October 2015

Published In

Volume / Issue

  • 24 / 10

Start / End Page

  • 2142 - 2149

PubMed ID

  • 25772089

Electronic International Standard Serial Number (EISSN)

  • 1432-0932

Digital Object Identifier (DOI)

  • 10.1007/s00586-015-3862-9


  • eng

Conference Location

  • Germany