Disch Alexander C, Boriani Stefano, Luzzati Alessandro, Rhines Laurence D, Fisher Charles G, Lazary Aron, Gokaslan Ziya L, Chou Dean, Clarke Michelle J, Fehlings Michael G, Schaser Klaus-Dieter, Germscheid Nicole M, Reynolds Jeremy J
University Center for Orthopedics, Trauma & Plastic Surgery, University Comprehensive Spine Center (UCSC), University Hospital Carl Gustav Carus Dresden at the TU Dresden, 01307 Dresden, Germany.
I.R.C.C.S. Istituto Ortopedico Galeazzi, 20161 Milan, Italy.
Cancers (Basel). 2023 Jan 30;15(3):845. doi: 10.3390/cancers15030845.
Extradural malignant primary spinal tumors are rare and outcome data, especially for younger patients, is limited. In a worldwide (11 centers) study (Predictors of Mortality and Morbidity in the Surgical Management of Primary Tumors of the Spine study; ClinicalTrials.gov Identifier NCT01643174) by the AO Spine Knowledge Forum Tumor, patients surgically treated for primary tumors of the spine between 1992 and 2012, were retrospectively analyzed from a prospective database of their medical history. Medical history, tumor characteristics, diagnostics, treatments, cross-sectional survival, and local recurrences were analyzed. Sixty-eight cases (32 f; 36 m), at an average age of 18.6 ± 4.7 years at the time of diagnosis, were identified (median follow-up 2.9 years). The most common entities were Ewing's sarcoma (42.6%). Of the patients, 28% had undergone previous spine tumor surgery in another center (84% with intralesional margins). Resection was considered "Enneking appropriate" (EA) in 47.8% of the cases. Of the patients, 77.9% underwent chemotherapy and 50% radiotherapy. A local recurrence occurred in 36.4%. Over a third of patients died within a 10-year follow-up period. Kaplan-Meier-analysis demonstrated statistically significant overall survival ( = 0.007) and local recurrence rates ( = 0.042) for tumors treated with EA surgery versus Enneking inappropriate surgery. Aggressive resection of extradural primary malignant spinal tumors combined with adjuvant therapy reveals low local recurrence rates and better outcomes overall in younger patients.
硬膜外原发性脊柱恶性肿瘤较为罕见，尤其是针对年轻患者的预后数据有限。在一项由AO脊柱肿瘤知识论坛开展的全球范围（11个中心）研究（脊柱原发性肿瘤手术治疗中死亡率和发病率的预测因素研究；ClinicalTrials.gov标识符NCT01643174）中，对1992年至2012年间接受脊柱原发性肿瘤手术治疗的患者，从其病史的前瞻性数据库中进行了回顾性分析。分析了病史、肿瘤特征、诊断、治疗、横断面生存率和局部复发情况。共确定了68例患者（32例女性；36例男性），诊断时的平均年龄为18.6±4.7岁（中位随访时间2.9年）。最常见的类型是尤因肉瘤（42.6%）。其中，28%的患者曾在其他中心接受过脊柱肿瘤手术（84%为病损内边界）。47.8%的病例中切除被认为是“恩neking合适的”（EA）。77.9%的患者接受了化疗，50%接受了放疗。局部复发率为36.4%。超过三分之一的患者在10年随访期内死亡。Kaplan-Meier分析显示，与恩neking不合适手术相比，EA手术治疗的肿瘤总体生存率（ = 0.007）和局部复发率（ = 0.042）具有统计学意义。对硬膜外原发性恶性脊柱肿瘤进行积极切除并联合辅助治疗，在年轻患者中显示出较低的局部复发率和总体更好的预后。
