Tomita及改良Tokuhashi结合脊柱肿瘤不稳评分在脊柱转移瘤患者治疗决策中的可信度和可重复性研究

Intra- and interobserver concordance evaluation of Tomita with SINS scoring system and Tokuhashi with SINS scoring system for decision making in spinal metastases

中文关键词:  脊柱转移瘤  Tomita评分  改良Tokuhashi 评分  脊柱肿瘤不稳定评分  可信度  可重复性

英文关键词:Spinal metastases  Tomita scoring system  Revised Tokuhashi scoring system  SINS scoring system  Intraobserver concordance  Interobserver concordance

中文摘要:

  【摘要】 目的：分析Tomita评分结合脊柱肿瘤不稳评分（spinal instability neoplastic score，SINS）和改良Tokuhashi评分结合SINS评分用于脊柱转移瘤患者治疗决策的可信度和可重复性，评价两套评分系统临床运用价值。方法：3名具有一定临床经验的脊柱外科医生对41例脊柱转移瘤患者进行回顾性分析。这3名脊柱外科医生用Tomita评分、改良Tokuhashi评分、SINS评分对每位患者进行评分，并运用改良Tokuhashi结合SINS评分及Tomita结合SINS评分决定患者的治疗方案。间隔20天后对上述病例进行重复分析，分析观察者间一致性和观察者内一致性。结果：Tomita结合SINS评分用于治疗决策时，平均观察者间一致性Kappa值为0.78（0.75~0.81），平均观察者内一致性Cronbach′s α系数为0.79（0.77~0.82）。改良Tokuhashi 结合SINS评分用于治疗决策时，平均观察者间一致性Kappa值为0.68（0.65~0.72），平均观察者内一致性Cronbach′s α系数为0.73（0.72~0.75）。有17.9%的患者在两组系统评估后而得出不同治疗方案。结论：Tomita结合SINS评分和改良Tokuhashi结合SINS评分均具有较好的可信度和可重复性。

英文摘要:

  【Abstract】 Objectives: To investigate the intra- and interobserver concordance of Tomita with spinal instability neoplastic score(SINS) scoring system and Tokuhashi with SINS scoring system in defining the treatment of vertebral metastatic lesions. Methods: Forty-one cases of vertebral metastatic lesions were presented to three spinal surgeons. All cases were evaluated by the three spine surgeons based on Tomita scoring system, revised Tokuhashi scoring system and SINS scoring system. Then the intra- and interobserver concordance was evaluated accordingly. The treatment was also decided by Tomita with SINS scoring system and Tokuhashi with SINS scoring system respectively. The repeated evaluation was employed at 20 days after the first time evaluation. Results: The intraobserver consistency of Tomita with SINS scoring system was 0.78(0.75-0.81), while interobserver consistency validity was 0.79(0.77-0.82). The intraobserver consistency of Tokuhashi with SINS scoring system was 0.68(0.65-0.72), while interobserver consistency was 0.73(0.72-0.75). 17.9% of the cases changed the treatment approach by using the two different scoring systems. Conclusions: This study demonstrats that Tomita with SINS scoring system has higher intra- and interobserver concordance compared with Tokuhashi with SINS scoring system, which can be used as a routine scoring system. Tokuhashi with SINS scoring system is more valuable in decision making as it includes the evaluation of general health situation and neurological status.