Jia Qi, Yin Huabin, Yang Jian, Wu Zhipeng, Yan Wangjun, Zhou Wang, Yang Xinghai, Xiao Jianru
Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Huangpu District, Shanghai, China.
Department of Orthopedics, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, 100 Haining Road, Shanghai, China.
Eur Spine J. 2018 Apr;27(4):859-867. doi: 10.1007/s00586-017-5140-5. Epub 2017 Jun 26.
Spinal metastatic paraganglioma (MPG) is rare and only reported in individual case reports. The low incidence makes it difficult to define appropriate therapy and prognosis. Our study illustrated the largest series to discuss the possible treatment and outcomes of patients with spinal MPG.
A retrospective study of 15 patients with spinal MPG who were surgically treated between 2005 and 2014 was performed. Three surgical modalities were applied, and radiotherapy and chemotherapy were utilized as adjuvant therapy.
The mean patients age was 40.9 (range 23-58) years. The period between primary surgery and spinal metastasis averaged 8.2 (0.5-15) years. Lesions were mainly located in cervical spine (2), thoracic spine (8), lumbar spine (3), and sacrum (2). The mean follow-up period was 35.0 months. Lesion progression was detected in nine patients, whereas five patients (33.3%) passed away. For solitary spine, multiple bone and both bone and nonosseous metastasis cases, the mean progression-free survival was 41 (range 9-56), 22.5 (range 12-38) and 8.3 (range 3-18) months, respectively.
The cases presented in the current study highlight the crucial role of surgery. Total en bloc for solitary spinal MPG could result in a satisfying prognosis and piecemeal total resection with postoperative radiotherapy could be an alternative therapy. Radiotherapy and chemotherapy were advocated, especially for the multiple metastasis.
脊柱转移性副神经节瘤（MPG）较为罕见，仅有个别病例报告。其低发病率使得难以确定合适的治疗方法和预后情况。我们的研究展示了最大规模的系列病例，以探讨脊柱MPG患者可能的治疗方法及结果。
对2005年至2014年间接受手术治疗的15例脊柱MPG患者进行回顾性研究。采用了三种手术方式，并将放疗和化疗用作辅助治疗。
患者的平均年龄为40.9岁（范围23 - 58岁）。初次手术至脊柱转移的平均时间为8.2年（0.5 - 15年）。病变主要位于颈椎（2例）、胸椎（8例）、腰椎（3例）和骶骨（2例）。平均随访期为35.0个月。9例患者出现病变进展，5例患者（33.3%）死亡。对于孤立性脊柱、多发骨以及骨与非骨转移病例，平均无进展生存期分别为41个月（范围9 - 56个月）、22.5个月（范围12 - 38个月）和8.3个月（范围3 - 18个月）。
本研究中的病例突出了手术的关键作用。对于孤立性脊柱MPG进行整块切除可获得满意的预后，而分块全切除联合术后放疗可能是一种替代治疗方法。提倡放疗和化疗，尤其是对于多发转移患者。
