Scoring system for prediction of metastatic spine tumor prognosis

Table 1 Tokuhashi score original (1990)[1-3]

Predictive factor	Score (points)
General condition (KPS)
Poor (KPS 10%-40%)	0
Moderate (KPS 50%-70%)	1
Good (KPS 80%-100%)	2
Number of extraspinal bone metastases foci
≥ 3	0
1-2	1
0	2
Number of metastases in the vertebral body
≥ 3	0
2	1
1	2
Metastases to the major internal organs
Unremovable	0
Removable	1
No metastases	2
Primary site of the cancer
Lung, stomach	0
Kidney, liver, uterus, others, unidentified	1
Thyroid, prostate, breast, rectum	2
Spinal cord palsy
Complete (Frankel A, B)	0
Incomplete (Frankel C, D)	1
None (Frankel E)	2
Total points	Mean survival periods
0-5	≤ 3 mo
6-8	≤ 12 mo
9-12	≤ 12 mo

KPS: Karnofsky’s performance status.

Table 2 Revised Tokuhashi score (2005)[4]

Predictive factor	Score (points)
General condition (KPS)
Poor (KPS 10%-40%)	0
Moderate (KPS 50%-70%)	1
Good (KPS 80%-100%)	2
Number of extraspinal bone metastases foci
≥ 3	0
1-2	1
0	2
Number of metastases in the vertebral body
≥ 3	0
2	1
1	2
Metastases to the major internal organs
Unremovable	0
Removable	1
No metastases	2
Primary site of the cancer
Lung, osteosarcoma, stomach, bladder, esophagus, pancreas	0
Liver, gallbladder, unidentified	1
Others	2
Kidney, uterus	3
Rectum	4
Thyroid, prostate, breast, carcinoid tumor	5
Spinal cord palsy
Complete (Frankel A, B)	0
Incomplete (Frankel C, D)	1
None (Frankel E)	2
Total points	Mean survival periods
0-8	< 6 mo
9-11	≥ 6 mo
12-15	≥ 12 mo

KPS: Karnofsky’s performance status.

Table 3 Tomita score (2001)[23,24]

Prognostic factors	Points
Primary tumor
Slow growth (breast, thyroid, etc.)	1
Moderate growth (Kidney, uterus, etc.)	2
Rapid growth (Lung, stomach, etc.)	4
Visceral metastases
Treatable	2
Untreatable	4
Bone metastases
Solitary or isolated	1
Multiple	2
Total points	Predicted prognosis
2-4	> 2 yr
4-6	1-2 yr
6-8	6-12 mo
8-10	< 3 mo

Table 4 Baur score original

Positive prognostic factors	Score (Points)
No visceral metastases	1
Absence of pathologic fracture	1
solitary skeletal metastasis	1
No lung cancer	1
Primary tumor = breast, kidney, lymphoma, multiple myeloma	1
Total score (points)	1-yr survival rate (%)
0-1	0% (< 6 mo survival)
2-3	25%
4-5	50%

Table 5 Modified Baur score

Positive prognostic factors	Points
No visceral metastases	1
No lung cancer	1
Primary tumor = breast, kidney, lymphoma, multiple myeloma	1
One solitary skeletal metastasis	1
Total points	Median overall survival
0-1	4.8 mo
2	18.2 mo
3-4	28.4 mo

Table 6 Linden score

Prognostic factors	Points
Karnofsky performance status
80-100	2
50-70	1
20-40	0
Primary tumor
Breast	3
Prostate	2
Lung	1
Other	0
Visceral metastases
No	1
Yes	0
Total points	Mean overall survival
0-3 (n = 116)	4.8 mo
4-5 (n = 164)	13.1 mo
6 (n = 62)	18.3 mo

Table 7 Rades score

Prognostic factor	Score (points)
Type of primary tumor
Breast cancer	8
Prostate cancer	7
Myeloma/lymphoma	9
Lung cancer	3
Other tumors	4
Other bone metastases at the time of RT
Yes	5
No	7
Visceral metastases at the time of RT
Yes	2
No	8
Interval from tumor diagnosis to MSCC
≤ 15 mo	4
> 15 mo	7
Ambulatory status before RT
Ambulatory	7
Nonambulatory	3
Time of developing motor deficits before RT
1-7 d	3
8-14 d	6
> 14 d	8
Total score	6-mo survival (%)
20-30 (n = 237)	16
31-35 (n = 162)	48
36-46 (n = 253)	81

RT: Radiotherapy; MSCC: Metastatic spinal cord compression.

Table 8 Rades score for prostate cancer metastases

Prognostic factor	Score (points)
ECOG performance status
1-2	9
3-4	4
Ambulatory status prior to RT
Not ambulatory	4
Ambulatory before RT	8
Other bone metastases
No	7
Yes	5
Visceral metastases
No	8
Yes	2
Interval from cancer diagnosis to RT
≤ 15 mo	5
> 15 mo	7
Score group	Survival at 6 mo (%)
20-24 (n = 58)	6.5-7.4
25-34 (n = 189)	44.6-45.4
35-39 (n = 189)	94.7-95.8

ECOG : Eastern Cooperative Oncology Group. RT: Radiotherapy.

Table 9 Rades score for breast cancer metastases

Prognostic factor	Score (points)
ECOG performance status
1-2	9
3-4	5
Ambulatory status prior to RT
Not ambulatory	4
Ambulatory before RT	8
Other bone metastases
No	8
Yes	7
Visceral metastases
No	9
Yes	4
Interval from tumor diagnosis to radiotherapy of MSCC
≤ 15 mo	6
> 15 mo	8
Time of developing motor deficits
1-7 d	4
> 7 d	8
Total score	Survival at 6 mo (%)
30-35	12-14
36-40	41-46
41-45	74-77
46-50	98-99

ECOG: Eastern Cooperative Oncology Group. RT: Radiotherapy; MSCC: Metastatic spinal cord compression.

Table 10 Douglas score for unknown primary metastases

Prognostic factor	Score (points)
ECOG performance status
1-2	6
3-4	2
Ambulatory status prior to RT
Not ambulatory	2
Ambulatory before RT	4
Visceral metastases
No	5
Yes	0
Time of developing motor deficits
1-7 d	1
> 7 d	5
Score group	Survival at 6 mo (%)
< 14 (n = 112)	5-7
14-16 (n = 26)	38-41
> 16 (n = 24)	91-92

ECOG: Eastern Cooperative Oncology Group. RT: Radiotherapy.

Table 11 Katagiri score

Prognostic factor	Score
Primary lesion
Rapid growth( Hepatocellular carcinoma, gastric carcinoma, lung carcinoma)	3
Slow growth( Breast carcinoma, prostate carcinoma, multiple myeloma, malignant lymphoma, thyroid carcinoma)	0
Moderate growth( Other carcinoma and sarcoma)	2
Visceral or cerebral metastases	2
Performance status (ECOG) 3 or 4	1
Previous chemotherapy	1
Multiple skeletal metastases	1
Total score (n = 350)	6 and 12 mo survival rate (%)
0-2	97.9; 89.1
3-5	70.6; 48.8
6-8	31.3; 10.9

ECOG: Eastern Cooperative Oncology Group.

Table 12 Rades risk score for death within 2 mo after radiotherapy

Characteristic	Score( points)
ECOG performance status
2	0
3-4	4
Tumor type
Breast cancer	1
Prostate cancer	2
Myeloma/lymphoma	1
Lung cancer	3
Other	3
Further bone metastases
No	1
Yes	3
Visceral metastases
No	1
Yes	4
Interval from cancer diagnosis to MSCC
≤ 15 mo	3
> 15 mo	1
Ambulatory status prior to RT
Not ambulatory	4
Ambulatory before RT	1
Time of developing motor deficits
1-7 d	4
> 7 d	1

ECOG: Eastern Cooperative Oncology Group; MSCC: Metastatic spinal cord compression; RT: Radiotherapy.

Table 13 Crnalic score for prostate cancer metastases

Prognostic factor	Score (points)
Hormone status
Hormone native	2
Hormone refractory	0
KPS (%)
80-100	2
≤ 70	0
Visceral metastasis
Absent	1
Present	0
PSA (ng/mL)
Hormone native	1
Hormone refractory
< 200	1
≥ 200	0
Total points	Median overall survival
0-1	3 mo
2-4	16 mo
5-6	61.7 mo

KPS: Karnofsky performance score; PSA: prostate-specific antigen.