Analysis of Tokuhashi Score

70% of all cancer patients develop some form of visceral (internal organs) or skeletal
metastases (spread of disease). Approximately one third of cancer patients develop
metastases to the spinal column. The prognosis once spinal metastases have been diagnosed
and the most appropriate treatment still remains controversial. To date there is no one
good diagnostic tool to predict survival and/or outcome after radiotherapy or surgical
intervention.

Tokuhashi, et al, formulated and presented a preoperative scoring system to evaluate
indications for surgery and predict outcome in patients with metastases to the spinal
column. Six variables are measured to calculate this score: general medical condition,
number of extraspinal metastases, number of vertebral metastases, status of metastases to
the major internal organs, primary tumor type, and presence of a neurologic deficit. This
scoring system has been gaining acceptance in literature. In 1998, Tokuhashi, et al,
modified this scoring system by diversifying the tumor types into six categories. After a
retrospective analysis Tokuhashi reported that patients with scores less than or equal to 8
will die of their disease within 6 months and those with scores of 12 or greater will
survive an average of 12 months or more.

The purpose of this study is to determine 1) the Tokuhashi score's validity in predicting
survival after developing spinal metastases, 2) the relationship of treatment on survival
after detecting spinal metastases in relation to the Tokuhashi score. Patients will be
enrolled into the study and followed prospectively for as long as possible regardless of
intervention.

There will be three groups based on their Tokuhashi score, each group will require
approximately 163 subjects statistically.