Tan Jonathan Jiong Hao, Stirling Euan, Kaiser Radek, Mawhinney Gerard, Rothenfluh Dominique, Chan Yiong Huak, Wang Shilin, Mihai Ruxandra, Bojanic Stana, Reynolds Jeremy
Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore.
Oxford Spinal Surgery Unit, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK.
Eur Spine J. 2025 May 31. doi: 10.1007/s00586-025-08893-y.
The Oxford Spinal Sarcoma Service is a designated primary spinal tumour referral centre in the United Kingdom serving over ten million residents. We report the outcomes of this centralised approach to primary spinal tumour care.
This is a retrospective review of surgically treated primary spinal tumour patients during 2008-2022. Patients were classified based on tumour resection margins - Enneking Appropriate (EA) or Enneking Inappropriate (EI). Outcomes studied include local recurrence and overall survival.
119 patients were included. 86/119(72%) cases involved the mobile spine; 33/119(28%), the sacrum. 96/119(81%) patients were virgin cases. EA margins were achieved in 68%(81/119) of cases. There were 38/119(32%) EI patients; 23/38(61%) were non-virgin cases which precluded EA resection. EA resection was achieved 90%(81/90) of the time when attempted. In EA patients with mobile spine tumours, local recurrence rate was 2%(1/51), vs. 18%(5/28) in EA patients with sacral tumours, 20%(7/35) in EI patients with mobile spine tumours, and 80%(4/5) in EI patients with sacral tumours. Mean local recurrence-free survival was 5.2(range 1-13.5) years; local recurrence rate, 18.5%(22/119). Mortality rate was 21.0%(25/119); mean overall survival was 5.63(range 1-13.5) years post-surgery. On multivariate analysis, EI margins and post-operative systemic treatment were significant predictors for local recurrence; presence of metastases and pre-operative systemic therapy, significant predictors for mortality.
Centralisation of primary spinal tumour care has led to excellent oncological results comparable to most large spinal tumour centres. In mobile spine primary tumours where EA margins were achieved, our local recurrence rate (2.0%) is one of the lowest reported in literature.
牛津脊柱肉瘤服务中心是英国指定的原发性脊柱肿瘤转诊中心，服务超过1000万居民。我们报告了这种集中式原发性脊柱肿瘤护理方法的结果。
这是一项对2008年至2022年期间接受手术治疗的原发性脊柱肿瘤患者的回顾性研究。患者根据肿瘤切除边缘进行分类——Enneking适当（EA）或Enneking不适当（EI）。研究的结果包括局部复发和总生存期。
纳入119例患者。119例中有86例（72%）累及活动脊柱；119例中有33例（28%）累及骶骨。119例中有96例（81%）患者为初治病例。68%（81/119）的病例实现了EA边缘切除。有38/119（32%）例EI患者；38例中有23例（61%）为非初治病例，这排除了EA切除。尝试进行EA切除时，90%（81/90）的情况下成功实现了EA切除。在活动脊柱肿瘤的EA患者中，局部复发率为2%（1/51），而骶骨肿瘤的EA患者中为18%（5/28），活动脊柱肿瘤的EI患者中为20%（7/35），骶骨肿瘤的EI患者中为80%（4/5）。平均无局部复发生存期为5.2年（范围1 - 13.5年）；局部复发率为18.5%（22/119）。死亡率为21.0%（25/119）；术后平均总生存期为5.63年（范围1 - 13.5年）。多因素分析显示，EI边缘和术后全身治疗是局部复发的重要预测因素；存在转移和术前全身治疗是死亡率的重要预测因素。
原发性脊柱肿瘤护理的集中化带来了与大多数大型脊柱肿瘤中心相当的出色肿瘤学结果。在实现了EA边缘切除的活动脊柱原发性肿瘤中，我们的局部复发率（2.0%）是文献报道中最低的之一。
