Tomita评分及改良Tokuhashi评分对脊柱转移瘤手术患者生存期预测的准确性

The accuracy of Tomita score and revised Tokuhashi score in predicting postoperative survival of patients with spinal metastases in the past decade

中文关键词:  脊柱转移瘤  Tomita评分  改良Tokuhashi评分  生存期预测

英文关键词:Spinal metastases  Tomita score  Revised Tokuhashi score  Survival prediction

中文摘要:

  【摘要】 目的：分析Tomita评分及改良Tokuhashi评分对脊柱转移瘤手术患者生存期预测的准确性。方法：回顾性分析我院2010年3月~2019年7月因脊柱转移瘤行初次手术治疗患者的临床资料，纳入末次随访前已去世或随访时间≥12个月的患者。通过Kaplan-Meier生存分析和log-rank检验，分析患者整体样本及常见的五种病理类型（肺癌、肾癌、乳腺癌、甲状腺癌、前列腺癌）脊柱转移瘤的生存时间，比较Tomita评分及改良Tokuhashi评分不同分组间差异。并通过比较患者的实际生存时间与Tomita评分及改良Tokuhashi评分预测的生存时间来判断这两种评分在不同分组及上述五种病理类型脊柱转移瘤中的预测准确性。结果：共221例患者纳入本研究，末次随访时94例（42.5%）存活，存活患者的中位随访时间为24个月（12~108个月）。纳入患者的中位生存时间为27.0个月（95%CI：22.1~31.9个月），1年生存率为67.4%。Tomita评分2~3分、4~5分、6~7分和8~10分患者的中位生存时间分别为34.0个月（95%CI：22.3~45.7个月）、41.0个月（95%CI：19.1~62.9个月）、16.0个月（95%CI：5.2~26.8个月）和12.0个月（95%CI：2.1~21.9个月）（P＜0.001）。改良Tokuhashi评分0~8分、9~11分和12~15分患者的中位生存时间分别为18.0个月（95%CI：11.6~24.4个月）、30.0个月（95%CI：16.2~43.8个月）和51.0个月（95%CI：33.2~68.8个月）（P＜0.001）。在所有患者中，Tomita评分可准确预测30.2%（57/189）患者的生存时间，改良Tokuhashi评分可准确预测32.6%（72/221）患者的生存时间。仅Tomita评分2~3分和改良Tokuhashi评分12~15分的预测准确性大于50%。在五种常见的病理类型中，Tomita评分对乳腺癌脊柱转移瘤、改良Tokuhashi评分对甲状腺癌脊柱转移瘤的预测准确性相对较好，分别为43.5%和56.3%；二者对肺癌脊柱转移瘤的预测准确性最差，Tomita评分和改良Tokuhashi评分对其预测准确性分别为22.2%和26.3%。结论：Tomita评分及改良Tokuhashi评分在整体上仍可以较好地区分不同生存时间等级的患者，但是不同等级患者的实际生存时间均比预测长。其对个体预测准确性仍不满意，尤其是对肺癌脊柱转移瘤的患者。

英文摘要:

  【Abstract】 Objectives: To analyze the accuracy of Tomita score and revised Tokuhashi score in predicting the postoperative survival of patients with spinal metastases in the past decade. Methods: A retrospective analysis of patients who underwent initial surgery for spinal metastases at Peking University Third Hospital between March 2010 and July 2019 was conducted. Follow-up time was no less than 12 months or until the patients′ death. Overall survival time of all patients and patients with the five common pathological types (lung, renal, breast, thyroid, and prostate cancer) was analyzed through Kaplan-Meier analysis, and a log-rank test was used to compare the Tomita scores and the revised Tokuhashi scores between different groups. By comparing the actual survival time of patients with the survival time predicted by the Tomita score and the revised Tokuhashi score, the prediction accuracy of these two scores in different groups and the above five pathological types was calculated. Results: A total of 221 patients were included in the study, with 94 patients (42.5%) who survived at final follow-up. The median survival time of the included patients was 27.0 months (95%CI: 22.1-31.9 months), and the 1-year survival rate was 67.4%. The median survival time of patients with Tomita scores of 2-3, 4-5, 6-7 and 8-10 points were 34.0 months(95%CI: 22.3-45.7 months), 41.0 months (95%CI: 19.1-62.9 months), 16.0 months (95%CI: 5.2-26.8 months), and 12.0 months (95%CI: 2.1-21.9 months)(P<0.001), respectively. The median survival time of patients with revised Tokuhashi scores of 0-8, 9-11 and 12-15 points were 18.0 months (95%CI: 11.6-24.4 months), 30.0 months (95%CI: 16.2-43.8 months) and 51.0 months (95%CI: 33.2-68.8 months) (P<0.001), respectively. In all patients, the Tomita score can accurately predict the survival time of 30.2% (57/189) patients, and the revised Tokuhashi score can accurately predict the survival time of 32.6%(72/221) patients. Prediction accuracy greater than 50% was only in Tomita score 2-3 points and revised Tokuhashi score 12-15 points. Among the five common pathological types, Tomita score had relatively good prediction accuracy for breast cancer(43.5%) and revised Tokuhashi score for thyroid cancer (56.3%). The prediction accuracy of lung cancer was the worst, with Tomita score and revised Tokuhashi score of 22.2% and 26.3%, respectively. Conclusions: Tomita score and revised Tokuhashi score can still distinguish patients with different survival time grades. However, the actual survival time of patients with different grades has greatly improved. It is still not satisfied with the accuracy of individual survival prediction, especially for patients with lung cancer metastases.