Journal List > J Korean Soc Spine Surg > v.26(Suppl 1) > 1142092

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

Abstract

Study Design

A retrospective multi-center study.

Objectives

To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma.

Summary of Literature Review

Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy.

Materials and Methods

We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test.

Results

Thirty-three patients (21 males, 12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004).

Conclusions

Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma.

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Fig. 1.
Distribution of patients according to the type of surgical resection and surgical margin.
jkss-26-117f1.tif
Fig. 2.
Kaplan-Meier survival curve of the total cohort showing an improvement in overall postoperative survival in patients who underwent total en bloc resection and had a negative margin
jkss-26-117f2.tif
Fig. 3.
(A) Kaplan-Meier survival curve for local recurrence showing significantly less recurrence in patients who underwent total en bloc re-section with a negative margin (p=0.004, log-rank test). (B) Kaplan-Meier survival curve for distant metastasis showing significantly less metastasis in patients who underwent total en bloc resection with a negative margin (p=0.025, log-rank test).
jkss-26-117f3.tif
Fig 4.
(A–D) A 63-year-old woman was diagnosed with osteosarcoma at the T7 level, which encased the descending thoracic aorta over the T5–8 levels. (E, F) The patient underwent total en bloc resection of the tumor, combined with replacement of the descending thoracic aorta by a thoracic surgeon. The postoperative X-ray is shown. (G, H) The specimen from the operation is shown. The patient experienced transient paraplegia due to spinal cord infarction, and currently ambulates using a walker. The patient had no evidence of disease after 4 years of follow-up.
jkss-26-117f4.tif
Table 1.
Summary of Osteosarcoma Patients
Case Gender/Age Site Resection type Surgical Margin Local recurrence Distant metastasis Follow up (month) Final status
1 M/23 L2 Total, En bloc Negative No No 96 NED
2 M/49 Sacrum Total, En bloc Negative No No 56 NED
3 F/63 T6-7-8 Total, En bloc Negative No No 48 NED
4 F/71 C4-5-6 Total, En bloc Negative No No 21 NED
5 M/16 T9 Total, En bloc Positive No No 43 NED
6 M/74 T3 Total, En bloc Positive No No 12 NED
7 F/34 Sacrum Total, En bloc Positive Yes Yes 33 DOD
8 M/65 T11-12 Total, Piecemeal   Yes No 20 AWD
9 M/9 T10-11 Total, Piecemeal   No No 27 NED
10 F/60 T12 Subtotal   NA Yes 36 AWD
11 M/55 T9-10 Subtotal   NA Yes 41 DOD
12 M/74 L3 Subtotal   NA Yes 12 DOD

Abbreviations: NED, ∗no evidence of disease: AWD, alive with disease, ∗DOD, death of disease: NA, not applicable.

Table 2.
Summary of Chondrosarcoma Patients
Case Gender/Age Site Resection type Surgical Margin Local recurrence Distant metastasis Follow up (month) Final status
1 F/41 T7 Total, En bloc Negative No No 255 NED
2 F/63 T10-11-12 Total, En bloc Negative No No 20 NED
3 M/32 L2-3 Total, En bloc Negative No No 25 NED
4 F/60 T4-8 Total, En bloc Negative No No 24 NED
5 F/55 T9-10-11 Total, En bloc Positive Yes Yes 36 AWD
6 F/25 L1 Total, Piecemeal   No No 78 NED
7 M/76 T11 Total, Piecemeal   No No 51 NED
8 M/71 T9-11 Total, Piecemeal   No No 6 NED
9 M/48 C4-5 Total, Piecemeal   Yes Yes 47 AWD
10 M/36 T4-6 Total, Piecemeal   Yes Yes 41 AWD
11 M/43 L4-5 Total, Piecemeal   Yes Yes 56 DOD
12 M/48 T9-12 Total, Piecemeal   Yes Yes 22 DOD
13 M/33 C5 Subtotal   NA No 47 AWD

Abbreviations: NED, ∗no evidence of disease: AWD, alive with disease, ∗DOD, death of disease: NA, not applicable.

The patient had a lung metastasis at the initial presentation of malignancy and was excluded from the survival analysis for the occurrence of distan metastasis.

Table 3.
Summary of Patients with Other Types of Sarcoma
Case Gender/ Age Diagnosis Site Resection type Surgical margin Local recurrence Distant metastasis Follow up (month) Final status
1 F/30 Langerhans cell sarcoma T12 Total, En bloc Negative No No 33 NED
2 M/60 Spindle cell sarcoma T12 Total, En bloc Negative No No 24 NED
3 F/40 Rhabdomyosarcoma Sacrum Total, En bloc Negative No No 15 NED
4 M/38 Synovial sarcoma C6-7-T1 Total, En bloc Negative No Yes 47 NED
5 M/10 Epithelioid sarcoma Sacrum Total, En bloc Positive No No 27 NED
6 M/37 Leiomyosarcoma T3 Total, Piecemeal   Yes Yes 15 AWD
7 F/36 Undifferentiated pleomorphic sarcoma L5 Total, Piecemeal   Yes Yes 144 DOD
8 M/16 Ewing's sarcoma T6 Total, Piecemeal   Yes Yes 54 DOD

Abbreviations: NED,∗no evidence of disease: AWD, ∗alive with disease: DOD, death of disease.

The patient is in NED state after lung metastectomy.

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