BACKGROUND CONTEXT: The decision for operative treatment of patients with spinal 
metastases is dependent on the patient's predicted survival. Tokuhashi, Tomita, 
Bauer, and Oswestry scores have been devised for survival prediction; however, 
none of these systems have been evaluated in nasopharyngeal carcinoma (NPC).
PURPOSE: To investigate the accuracy of these scoring systems in predicting 
survival and to identify prognostic factors for survival of the patients with 
spinal metastases from NPC.
STUDY DESIGN: Retrospective analysis of the patients with spinal metastases from 
NPC who were treated in our institution.
PATIENT SAMPLE: The study included 87 patients with spinal metastases from NPC.
OUTCOME MEASURES: The primary outcome measure was the survival time of these 
patients. The potential prognostic factors that are known to influence survival 
such as general condition, extraspinal bone metastases, vertebral bone 
metastases, visceral metastases, and neurologic assessment based on Frankel 
score were also studied.
METHODS: The predicted survival according to the four scoring systems were 
calculated and labeled as "A" scores. These patients were then rescored by 
assigning NPC as a good prognostic tumor and labeled as "B" scores. The 
predicted survival of scores A and B were compared with actual survival. 
Potential prognostic factors of survival were investigated using univariate and 
multivariate Cox regression analyses. For all scoring systems, Kaplan-Meier 
survival estimates and log-rank tests were done; the predictive values were 
calculated using postestimation after Cox regression analyses.
RESULTS: The median overall survival for the whole cohort was 13 (range 1-120) 
months. In multivariate analysis, general condition (p<.01), visceral metastases 
(p<.01), and vertebral metastases (p<.01) showed significant association with 
survival. The absolute score of all scoring systems was significantly associated 
with actual survival, which extended to the different prognostic subgroups of 
each scoring systems. Log-rank test revealed significant differences in survival 
between the different prognostic subgroups of all scoring systems (p<.01). 
Predictive value of survival by modified Tokuhashi score was the highest among 
all four scoring systems.
CONCLUSIONS: Patients with spinal metastases from NPC have relatively good 
survival prognosis. All four scoring systems could be used to prognosticate 
these patients. The modified Tokuhashi score is the best in doing so.