Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2021 Apr;148:e527-e535. doi: 10.1016/j.wneu.2021.01.020. Epub 2021 Jan 15.
Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants is controversial, often involving surgery, chemotherapy, and/or radiotherapy. This study sought to investigate current trends affecting overall survival (OS) using the National Cancer Database (NCDB) and to formulate treatment recommendations.
The National Cancer Database was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach.
A cohort of 102 patients with histologically confirmed spinal hemangiomas was identified in the database. Mean OS was 1.94 years. Administered treatments included partial surgical resection (n = 17), radical resection (n = 14), chemotherapy (n = 34), and radiotherapy (n = 56). Multivariate analysis revealed associations between decreased OS and advanced age (>65 years) and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose.
This retrospective analysis finding that treatment with surgical resection and/or radiotherapy is associated with increased OS constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.
脊柱血管瘤是椎体常见的原发性肿瘤。尽管这些肿瘤通常是良性且无症状的，但它们也可能表现出侵袭性生长并侵犯邻近结构。对于这些侵袭性变体的治疗存在争议，通常涉及手术、化疗和/或放疗。本研究旨在利用国家癌症数据库（NCDB）研究影响总生存（OS）的当前趋势，并制定治疗建议。
在 2004 年至 2016 年期间，国家癌症数据库中对脊柱血管瘤进行了查询。使用 Cox 比例风险模型对生存进行多变量回归分析。使用半参数 Cox 方法生成用于比较可视化人口统计学和治疗因素的生存曲线。
在数据库中确定了 102 例经组织学证实的脊柱血管瘤患者队列。平均 OS 为 1.94 年。接受的治疗包括部分手术切除（n=17）、根治性切除（n=14）、化疗（n=34）和放疗（n=56）。多变量分析显示，OS 降低与年龄较大（>65 岁）和存在转移有关。Cox 生存分析进一步显示，接受手术治疗和更高放射剂量的患者 OS 得到改善。
本回顾性分析发现，手术切除和/或放疗治疗与 OS 增加相关，这构成了迄今为止最大的侵袭性椎体血管瘤患者队列。鉴于研究队列的平均 OS 为 1.94 年，我们的研究结果表明，最大限度提高生存的最佳治疗方案应包括早期手术切除和辅助高剂量放疗。
