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

Mark B. Dekutoski, Michelle J. Clarke, Peter Rose, Alessandro Luzzati, Laurence D. Rhines, Peter P. Varga, Charles G. Fisher, Dean Chou, Michael G. Fehlings, Jeremy J. Reynolds, Richard Williams, Nasir A. Quraishi, Niccole M. Germscheid, Daniel M. Sciubba, Ziya L. Gokaslan, Stefano Boriani

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

Objective 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. Methods 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. Resu lts 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. Conclus ions 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.

Original languageEnglish (US)
Pages (from-to)59-68
Number of pages10
JournalJournal of Neurosurgery: Spine
Volume25
Issue number1
DOIs
StatePublished - Jul 2016

Keywords

  • En bloc resection
  • Neoadjuvant chemotherapy
  • Oncology
  • Osteosarcoma
  • Primary tumor
  • Spine
  • Surgery
  • Survival
  • Tumor

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

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