Osteosarcoma of the spine: prognostic variables for local recurrence and overall survival, a multicenter ambispective study

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Primary spinal osteosarcomas are rare and aggressive neoplasms. Poor outcomes can occur, as obtaining marginal margins is technically demanding; further Enneking-appropriate en bloc resection can have significant morbidity. The goal of this study is to identify prognostic variables for local recurrence and mortality in surgically treated patients diagnosed with a primary osteosarcoma of the spine.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A multicenter ambispective database of surgically treated patients with primary spine osteosarcomas was developed by AOSpine Knowledge Forum Tumor. Patient demographic, diagnosis, treatment, perioperative morbidity, local recurrence, and cross-sectional survival data were collected. Tumors were classified in 2 cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI), as defined by pathology margin matching Enneking-recommended surgical margins. Prognostic variables were analyzed in reference to local recurrence and survival.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Between 1987 and 2012, 58 patients (32 female patients) underwent surgical treatment for primary spinal osteosarcoma. Patients were followed for a mean period of 3.5 ± 3.5 years (range 0.5 days to 14.3 years). The median survival for the entire cohort was 6.7 years postoperative. Twenty-four (41%) patients died, and 17 (30%) patients suffered a local recurrence, 10 (59%) of whom died. Twenty-nine (53%) patients underwent EA resection while 26 (47%) patients underwent EI resection with a postoperative median survival of 6.8 and 3.7 years, respectively (p = 0.048). EI patients had a higher rate of local recurrence than EA patients (p = 0.001). Patient age, previous surgery, biopsy type, tumor size, spine level, and chemotherapy timing did not significantly influence recurrence and survival.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Osteosarcoma of the spine presents a significant challenge, and most patients die in spite of aggressive surgery. There is a significant decrease in recurrence and an increase in survival with en bloc resection (EA) when compared with intralesional resection (EI). The effect of adjuvant and neoadjuvant chemotherapeutics, as well as method of biopsy, requires further exploration.</jats:p></jats:sec>

The role of revision surgery and adjuvant therapy following subtotal resection of osteosarcoma of the spine: a systematic review with meta-analysis

“…1,13,31 Despite the moderate chemosensitivity of these tumors 23 and mild stabilization by radiation therapy, 11 achieving a marginal resection as the initial treatment has borne out as a strong predictor of survival in multiple studies. 9,14,23,26,27 However, in some patients an en bloc resection may not be possible at the initial presentation due to a lack of comprehensive multispecialty resources, anatomical limitations, or inconclusive pathology on initial specimen evaluation. Although the number of patient outcomes in the literature is limited following staged resection, this systematic review suggests a survival benefit with revision surgery.…”

Clinical Significance of Resection Type and Margin following Surgical Treatment for Primary Sarcoma of the Spine: A Multi-Center Retrospective Study

“…As anticipated, patients who were able to obtain marginal surgical margin showed superior results when compared to those of intralesional margin patients in survival analysis of this study, which is a similar result to previously published studies. [14][15][16] It should also be noted that the group of patients who had a total en bloc resection, but a positive surgical margin is different from the subtotal resection group. The former group only had a microscopic tumor left, predominantly in the interface between the tumor and the dural sac, but the latter group had a gross tumor unresected which was confirmed on the postoperative imaging studies.…”

Cisplatin inhibits the proliferation of Saos-2 osteosarcoma cells via the miR-376c/TGFA pathway

“…Due to the development of neoadjuvant chemotherapy and pulmonary metastasis resection, patients with osteosarcoma are no longer subjected to amputation but to limb salvage surgery instead, and their tumor-free survival rate has increased to about 60%-70%. However, high-dose chemotherapeutic agents have toxic side effects, accompanied by tumor cell mutation, primary or secondary drug resistance, early pulmonary metastasis, or local recurrence [2]. Moreover, it is rather difficult or even impossible to perform surgery for patients with osteosarcoma in the spine, the pelvis, or other special body parts as well as for patients at the advanced stage with recurrence or multiple metastatic foci.…”