Department of Orthopaedic Surgery, Centre Hospitalier Univeristaire de Québec, Laval University, Québec, Canada.
Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD.
Spine (Phila Pa 1976). 2018 May 1;43(9):622-629. doi: 10.1097/BRS.0000000000002386.
Multicenter, ambispective observational study.
To quantify mortality and local recurrence after surgical treatment of spinal Ewing sarcoma (ES) and to determine whether an Enneking appropriate procedure and surgical margins (en bloc resection with wide/marginal margins) are associated with improved prognosis.
Treatment of primary ES of the spine is complex. Ambiguity remains regarding the role and optimal type of surgery in the treatment of spinal ES.
The AOSpine Knowledge Forum Tumor developed a multicenter database including demographics, diagnosis, treatment, mortality, and recurrence rate data for spinal ES. Patients were stratified based on surgical margins and Enneking appropriateness. Survival and recurrence were analyzed using Kaplan-Meier curves and log-rank tests.
Fifty-eight patients diagnosed with primary spinal ES underwent surgery. Enneking appropriateness of surgery was known for 55 patients; 24 (44%) treated Enneking appropriately (EA) and 31 (56%) treated Enneking inappropriately (EI). A statistically significant difference in favor of EA-treated patients was found with regards to survival (P = 0.034). Neoadjuvant and postoperative chemotherapy was significantly associated with increased survival (P = 0.008). Local recurrence occurred in 22% (N = 5) of patients with an EA procedure versus 38% (N = 11) of patients with an EI procedure. The timing of chemotherapy treatment was significantly different between the Enneking cohorts (P < 0.001) and all EA-treated patients received chemotherapy treatment. Although, local recurrence was not significantly different between Enneking cohorts (P = 0.140), intralesional surgical margins and patients who received a previous spine tumor operation were associated with increased local recurrence (P = 0.025 and P = 0.018, respectively).
Surgery should be undertaken when an en bloc resection with wide/marginal margins is feasible. An EA surgery correlates with improved survival, but the impact of other prognostic factors needs to be evaluated. En bloc resection with wide/marginal margins is associated with local control.
多中心、前瞻性观察研究。
量化脊柱尤文肉瘤（ES）的手术治疗后的死亡率和局部复发率，并确定恩尼克（Enneking）适当的手术方法和手术切缘（整块切除加广泛/边缘性切缘）是否与改善预后相关。
脊柱原发性 ES 的治疗很复杂。在脊柱 ES 的治疗中，手术的作用和最佳类型仍存在争议。
AOSpine 肿瘤知识论坛建立了一个多中心数据库，包括脊柱 ES 患者的人口统计学、诊断、治疗、死亡率和复发率数据。根据手术切缘和恩尼克（Enneking）适宜性对患者进行分层。使用 Kaplan-Meier 曲线和对数秩检验分析生存和复发情况。
58 例诊断为原发性脊柱 ES 的患者接受了手术治疗。55 例患者的手术恩尼克（Enneking）适宜性已知；其中 24 例（44%）接受了恩尼克（Enneking）适宜性（EA）手术，31 例（56%）接受了恩尼克（Enneking）不适宜性（EI）手术。EA 治疗患者的生存情况有显著差异（P=0.034）。新辅助和术后化疗与生存率的提高显著相关（P=0.008）。局部复发发生在接受 EA 手术的患者中占 22%（N=5），而接受 EI 手术的患者中占 38%（N=11）。恩尼克（Enneking）两组患者的化疗治疗时间有显著差异（P<0.001），且所有 EA 治疗患者均接受了化疗治疗。虽然恩尼克（Enneking）两组患者的局部复发无显著差异（P=0.140），但肿瘤内手术切缘和接受过脊柱肿瘤手术的患者局部复发率较高（P=0.025 和 P=0.018）。
当可行整块切除加广泛/边缘性切缘时，应进行手术。EA 手术与生存率的提高相关，但需要评估其他预后因素的影响。整块切除加广泛/边缘性切缘与局部控制相关。
3 级。
