473 - Is Tokuhashi Score for Spinal Metastasis in Nasopharyngeal Carcinoma A...

#473 Is Tokuhashi Score for Spinal Metastasis in Nasopharyngeal Carcinoma Accurate?

Epidemiology-Natural History

Poster Presented by: Y. Lim


Y.S.E. Lim (1)
J.L. Lim (1)
Y. Chen (1)
G.K. Liu (1)
J. Thambiah (1)
H.K. Wong (1)
N.S. Kumar (1)

(1) National University Health System, Orthopaedic Surgery, Singapore, Singapore


Objectives: To evaluate spinal metastasis in nasopharyngeal carcinoma (NPC), with regards to the modality of treatment, survival outcome, duration of survival and accuracy of the Tokuhashi score in predicting prognosis of metastatic spinal disease.

Materials and Methods: We recruited 684 patients with the diagnosis of NPC, who presented to the National University Hospital, Singapore, from 2007 to 2011. Cases were classified by treatment modalities comprising of conservative treatment, radiotherapy, chemotherapy and surgery used either singly or in combination. Survival outcome at the point of data collection was analysed and mean duration of survival calculated.

We used the revised Tokuhashi score based on the 2005 publication by Tokuhashi et al which has a total of 15 points. Our study looked at the patient´s general condition (Karnofsky´s classification), number of extra-spinal bone metastasis, number of metastasis in the vertebral body, resectability of metastasis to the major internal organs, primary site of cancer and presence of neurological palsy based on Frankel´s classification.

Results: Of the 684 NPC patients, 89 (13%) had spinal metastasis. 84 (94%) of the 89 patients were treated non-surgically and 5 (6%) underwent surgery. At the point of data collection, 42 patients (50%) and 2 (40%) patients were alive in the non-surgical and surgical group respectively. Mean survival time was 421 and 264 days respectively.

Mean Tokuhashi score for both non-surgical and surgical groups was 7. Tokuhashi score of 0 to 8 predicts 85% of patients survive less than 6 months. However, 80% and 89% of patients in the non-surgical and surgical group outlived their prognosis of 6 months respectively.

NPC is assigned 2 points under the "others" category in the Tokuhashi scoring system. We found that when 5 points is assigned to NPC instead of 2, the new mean Tokuhashi score is 10 for both non-surgical and surgical groups. Tokuhashi score of 9 to 11 predicts that more than 30% of patients survive for more than 1 year. In our study, 71% and 56% of patients in non-surgical and surgical groups outlived their prognosis of 1 year respectively. This better correlates with the Tokuhashi´s scoring prognosis.

Conclusion: Spinal metastasis in NPC has a better prognosis when treated with either non-surgical or surgical modalities than predicted by the original Tokuhashi scoring system. The predicted survival time better correlates with actual survival time when 5 points is assigned to NPC in Tokuhashi scoring system as compared to 2 points.