Treatments and outcomes of primary and metastatic spinal angiosarcoma patients: study of 29 consecutive cases.

PURPOSE

Spinal angiosarcoma (AS) is rare, with limited understanding of its therapeutic outcomes and prognostic factors. This study aimed to evaluate the impact of surgery and adjuvant treatments on the prognosis of patients with primary and metastatic spinal AS, as well as potential prognostic factors affecting spinal AS patients.

METHODS

A retrospective review was conducted on 29 consecutive patients with spinal AS at our center from 2014 to 2023. We divided spinal AS patients into primary and metastatic groups, and analyzed the effects of surgical methods, along with adjuvant chemotherapy and radiotherapy, in the prognosis of the two groups. Additionally, the prognostic factors for progression-free survival (PFS) and overall survival (OS) were analyzed by using the univariate and multivariate analyses in spinal AS patients.

RESULTS

In isolated primary spinal AS patients, the 5-year OS and PFS rates were 47.9% and 44.9%, respectively. While the 5-year OS and PFS rates were both 0% in metastatic patients. Total tumor resection improved the OS of primary group (P = 0.023), but had limited impact on the prognosis of the metastatic group. Chemotherapy improved the OS of spinal AS patients (P = 0.047), and showed possible trend on improving prognosis in both groups though without statistical significance. Multivariate analysis confirmed that involved segments, surgical protocol, and preoperative C-reactive protein-to-albumin ratio (CAR) were independent prognostic factors for PFS, while preoperative metastasis, tumor size, and preoperative neutrophil-to-lymphocyte ratio (NLR) were the independent prognostic factors for OS in spinal AS patients.

CONCLUSION

Total tumor resection is recommended for primary spinal AS patients without metastasis. Chemotherapy may improve the OS of all spinal AS patients. Besides tumor size and range, metastasis, and surgical methods, inflammatory indicators including NLR and CAR may also function in the prognostic prediction of spinal AS patients.