STUDY DESIGN: A retrospective study of 180 patients with lung cancer spinal 
metastases, wherein prognostic score-predicted survival was compared with actual 
survival.
OBJECTIVE: To evaluate and compare the accuracy of prognostic scoring systems in 
lung cancer spinal metastases.
SUMMARY OF BACKGROUND DATA: The modified Tokuhashi, Tomita, modified Bauer, and 
Oswestry scores are currently used to guide decisions regarding operative 
treatment of patients with spinal metastases. The best system for predicting 
survival in patients with lung cancer spinal metastases remains undetermined. 
The high incidence of spinal metastases from lung cancer and improved survival 
of patients treated with systemic therapy warrants evaluation of these scoring 
systems in this particular context.
METHODS: Patients with lung cancer spinal metastases treated at our institution 
between May 2001 and August 2012 were studied. Fifty-one patients were treated 
surgically. The primary outcome measure was survival from the time of diagnosis. 
Scoring-predicted survival was compared with actual survival. Potential 
prognostic factors were investigated using Cox regression analyses. Predictive 
values of each scoring system for 3- and 6-month survival were measured via 
receiver operating characteristic (ROC) curves.
RESULTS: Histological subtype (P = 0.015), sex (P = 0.001), Karnofsky 
performance scale (P = 0.001), extent of neurological palsy (P = 0.002), and 
visceral metastases (P = 0.037) are significant predictors of survival. Besides 
the Oswestry spinal risk index, no significant differences were found between 
different prognostic subgroups within the individual scoring systems. Although 
the modified Bauer score was most accurate, all four scoring systems had areas 
under the ROC curve 0.5 or less.
CONCLUSION: Although better prognostic scores correlated with longer survival, 
all four scoring systems are inaccurate in prognosticating patients with lung 
cancer spinal metastases. Specific lung cancer histology appears prognostic and 
should be considered, especially given the increased survival of patients 
receiving new targeted therapies appropriate to their disease.
LEVEL OF EVIDENCE: 3.