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Escore de Tokuhashi (Metástases Vertebrais)
Clinical Context & Background
O Escore de Tokuhashi Revisado (2005) é um sistema de pontuação prognóstica para pacientes com metástases vertebrais. Avalia o estado geral, metástases ósseas extraespinais, número de metástases vertebrais, metástases em órgãos internos, sítio primário e paralisia medular. A pontuação total auxilia na decisão entre cirurgia excisional, cirurgia paliativa ou manejo não cirúrgico.
Referência: Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005;30(15):1786-1792.
Formula Logic
Soma de 6 parâmetros (0-15 pontos).Reference Data
| Pontuação Total | Sobrevida Estimada | Estratégia de Tratamento |
|---|---|---|
| 0 - 8 | < 6 meses | Conservador / Cirurgia Paliativa |
| 9 - 11 | ≥ 6 meses | Cirurgia Paliativa / Radioterapia |
| 12 - 15 | ≥ 1 ano | Cirurgia Excisional provavelmente apropriada |
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed Tokuhashi cases passed through visible production controls at scores 0, 10, and 15 across all survival bands.
- No unexpected N/A, literal undefined value, stale control, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/tokuhashi-spine-metastases-prognosis-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/tokuhashi-spine-metastases-prognosis.json.
: Browser input adapter corrected and reverified
- Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Full validation test
- 1,666/1,666 exhaustive source-combination, count and score-boundary, strict-input, UI/reset, trace, wording, immutability, registry, and no-panel checks passed with zero score or classification mismatches.
- Scope is the revised 2005 pretreatment score for established metastatic spinal tumors; no panel calculates Tokuhashi or inherits this verification.
: Calculation and input-contract correction
- Corrected the revised primary-site table: other primaries now score 2 points and kidney/uterus score 3 points, while rectum remains 4 and thyroid/prostate/breast/carcinoid remain 5.
- Replaced favorable point-coded defaults and unsafe summation with six required source-semantic inputs, raw integer metastasis counts, exact-key validation, and rejection of missing, extra, coercive, fractional, nonfinite, or unsupported values.
- Added an immutable six-contribution trace, exact 0-8, 9-11, and 12-15 historical survival rows, the correct publication citation, and explicit wording that vertebral multiplicity also informed the original treatment principles.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Evidence-based oncology decision support. Verify with clinical guidelines.