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Wang Q, Chen Y, Zhou G, Wang T, Fang J, Liu K, Qin S, Zhao W, Hao D, Lang N. Feasibility of ADC histogram analysis for predicting of postoperative recurrence in aggressive spinal tumors. J Bone Oncol 2025; 51:100666. [PMID: 40028630 PMCID: PMC11871475 DOI: 10.1016/j.jbo.2025.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 02/10/2025] [Accepted: 02/10/2025] [Indexed: 03/05/2025] Open
Abstract
Background Risk stratification of spinal tumors is a major unmet clinical need for personalized therapy. Purpose To explore the feasibility of pretreatment whole-lesion apparent diffusion coefficient (ADC) histogram in predicting local recurrence of aggressive spinal tumors. Methods 119 aggressive spinal tumor patients (median age, 40; range, 13-74 years) confirmed by pathological findings with a mean follow-up of 36 months were enrolled and divided into the recurrence and non-recurrence group. The histogram metrics of whole-lesion, including the maximum, mean, kurtosis, skewness, entropy, and percentiles (10th, 25th, 50th, 75th, 95th) ADC values, were evaluated and take the average. Fractal dimension (FD) was assessed in the three orthogonal directions and take maximum. Clinical and general imaging features were used to construct an alternative prognostic model for comparison. Variables with statistical differences would be included in stepwise logistic regression analysis. Results As for the clinical model, Enneking staging (odds ratio [OR]: 3.572; P = 0.04) and vertebral compression (OR: 4.302; P = 0.002) were independent predictors of recurrence. There was no statistical difference in FD between the two groups (P = 0.623). Among the ADC histogram parameters compared, skewness, maximum, and mean ADC values were independent risk factors and constructed ADC histogram prediction models. The ADC histogram model (AUC = 0.871) and the combined model (AUC = 0.884) performed better than the clinical prediction model (AUC = 0.704) with P-values of 0.004 and 0.001, respectively. Conclusion Prediction models based on the ADC histogram analysis might represent serviceable instruments for the aggressive spinal tumors.
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Affiliation(s)
- Qizheng Wang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Yongye Chen
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Guangjin Zhou
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Tongyu Wang
- Department of Radiology, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Qingdao 266000 Shandong, PR China
| | - Jingchao Fang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Ke Liu
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Siyuan Qin
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Weili Zhao
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
| | - Dapeng Hao
- Department of Radiology, the Affiliated Hospital of Qingdao University, No. 16 Jiangsu Rd, Qingdao 266000 Shandong, PR China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District 100069 Beijing, PR China
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Lam FC, Guru S, AbuReesh D, Hori YS, Chuang C, Liu L, Wang L, Gu X, Szalkowski GA, Wang Z, Wohlers C, Tayag A, Emrich SC, Ustrzynski L, Zygourakis CC, Desai A, Hayden Gephart M, Byun J, Pollom EL, Rahimy E, Soltys S, Park DJ, Chang SD. Use of Carbon Fiber Implants to Improve the Safety and Efficacy of Radiation Therapy for Spine Tumor Patients. Brain Sci 2025; 15:199. [PMID: 40002531 PMCID: PMC11852773 DOI: 10.3390/brainsci15020199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Revised: 01/22/2025] [Accepted: 02/13/2025] [Indexed: 02/27/2025] Open
Abstract
Current standard of care treatment for patients with spine tumors includes multidisciplinary approaches, including the following: (1) surgical tumor debulking, epidural spinal cord decompression, and spine stabilization techniques; (2) systemic chemo/targeted therapies; (3) radiation therapy; and (4) surveillance imaging for local disease control and recurrence. Titanium pedicle screw and rod fixation have become commonplace in the spine surgeon's armamentarium for the stabilization of the spine following tumor resection and separation surgery. However, the high degree of imaging artifacts seen with titanium implants on postoperative CT and MRI scans can significantly hinder the accurate delineation of vertebral anatomy and adjacent neurovascular structures to allow for the safe and effective planning of downstream radiation therapies and detection of disease recurrence. Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) spine implants have emerged as a promising alternative to titanium due to the lack of artifact signals on CT and MRI, allowing for more accurate and safe postoperative radiation planning. In this article, we review the tenants of the surgical and radiation management of spine tumors and discuss the safety, efficacy, and current limitations of CFR-PEEK spine implants in the multidisciplinary management of spine oncology patients.
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Affiliation(s)
- Fred C. Lam
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Santosh Guru
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Deyaldeen AbuReesh
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Yusuke S. Hori
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Cynthia Chuang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Lianli Liu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Lei Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Gregory A. Szalkowski
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Ziyi Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Christopher Wohlers
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Armine Tayag
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Sara C. Emrich
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Louisa Ustrzynski
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Corinna C. Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Atman Desai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - John Byun
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Erqi Liu Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Elham Rahimy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - Scott Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA; (C.C.); (L.L.); (L.W.); (X.G.); (G.A.S.); (Z.W.); (C.W.); (J.B.); (E.L.P.); (E.R.); (S.S.)
| | - David J. Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
| | - Steven D. Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (F.C.L.); (S.G.); (D.A.); (Y.S.H.); (A.T.); (S.C.E.); (L.U.); (A.D.); (M.H.G.); (D.J.P.)
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Jagtiani P, Karabacak M, Carr MT, Bahadir Z, Morgenstern PF, Margetis K. Exploring Pediatric Vertebral, Sacral, and Pelvic Osteosarcomas through the NCDB: Demographics, Treatment Utilization, and Survival Outcomes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1025. [PMID: 39201959 PMCID: PMC11353215 DOI: 10.3390/children11081025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 08/19/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND AND OBJECTIVES Retrieve data from the National Cancer Database (NCDB) to examine information on the epidemiological prevalence, treatment strategies, and survival outcomes of pediatric vertebral, sacral and pelvic osteosarcomas. METHODS We reviewed NCDB data from 2008 to 2018, concentrating on vertebral, sacral, and pelvic osteosarcomas in children 0 to 21 years. Our analysis involved logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. RESULTS The study population included 207 patients. For vertebral osteosarcomas, 62.5% of patients were female, and 78.1% were white. Regional lymph node involvement predicted 80 times higher mortality hazard (p = 0.021). Distant metastasis predicted 25 times higher mortality hazard (p = 0.027). For sacral and pelvic osteosarcomas, 58.3% of patients were male, and 72% were white. Patients with residual tumor were 4 times more likely to have prolonged LOS (p = 0.031). No residual tumor (HR = 0.53, p = 0.03) and radiotherapy receipt (HR = 0.46, p = 0.034) were associated with lower mortality hazards. Distant metastasis predicted 3 times higher mortality hazard (p < 0.001). Hispanic ethnicity was linked to lower resection odds (OR = 0.342, p = 0.043), possibly due to language barriers affecting patient understanding and care decisions. CONCLUSIONS In conclusion, our examination of NCDB offers a thorough exploration of demographics, treatment patterns, and results, highlighting the importance of personalized approaches to enhance patient outcomes.
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Affiliation(s)
- Pemla Jagtiani
- School of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203, USA;
| | - Mert Karabacak
- Department of Neurosurgery, Mount Sinai Health System, New York, NY 10029, USA; (M.K.); (M.T.C.); (P.F.M.)
| | - Matthew T. Carr
- Department of Neurosurgery, Mount Sinai Health System, New York, NY 10029, USA; (M.K.); (M.T.C.); (P.F.M.)
| | - Zeynep Bahadir
- Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, USA;
| | - Peter F. Morgenstern
- Department of Neurosurgery, Mount Sinai Health System, New York, NY 10029, USA; (M.K.); (M.T.C.); (P.F.M.)
| | - Konstantinos Margetis
- Department of Neurosurgery, Mount Sinai Health System, New York, NY 10029, USA; (M.K.); (M.T.C.); (P.F.M.)
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Fan G, Yang S, Qin J, Huang L, Li Y, Liu H, Liao X. Machine Learning Predict Survivals of Spinal and Pelvic Ewing's Sarcoma with the SEER Database. Global Spine J 2024; 14:1125-1136. [PMID: 36281905 PMCID: PMC11289541 DOI: 10.1177/21925682221134049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES This study aimed to develop survival prediction models for spinal Ewing's sarcoma (EWS) based on machine learning (ML). METHODS We extracted the SEER registry's clinical data of EWS diagnosed between 1975 and 2016. Three feature selection methods extracted clinical features. Four ML algorithms (Cox, random survival forest (RSF), CoxBoost, DeepCox) were trained to predict the overall survival (OS) and cancer-specific survival (CSS) of spinal EWS. The concordance index (C-index), integrated Brier score (IBS) and mean area under the curves (AUC) were used to assess the prediction performance of different ML models. The top initial ML models with best performance from each evaluation index (C-index, IBS and mean AUC) were finally stacked to ensemble models which were compared with the traditional TNM stage model by 3-/5-/10-year Receiver Operating Characteristic (ROC) curves and Decision Curve Analysis (DCA). RESULTS A total of 741 patients with spinal EWS were identified. C-index, IBS and mean AUC for the final ensemble ML model in predicting OS were .693/0.158/0.829 during independent testing, while .719/0.171/0.819 in predicting CSS. The ensemble ML model also achieved an AUC of .705/0.747/0.851 for predicting 3-/5-/10-year OS during independent testing, while .734/0.779/0.830 for predicting 3-/5-/10-year CSS, both of which outperformed the traditional TNM stage. DCA curves also showed the advantages of the ensemble models over the traditional TNM stage. CONCLUSION ML was an effective and promising technique in predicting survival of spinal EWS, and the ensemble models were superior to the traditional TNM stage model.
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Affiliation(s)
- Guoxin Fan
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, China
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, China
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Sheng Yang
- Department of Orthopedics, Shanghai Tenth Peoples Hospital, Tongji University School of Medicine, China
| | - Jiaqi Qin
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, China
| | - Longfei Huang
- Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, China
| | - Yufeng Li
- Department of Sports Medicine, The Eighth Affiliated Hospital Sun Yat-sen University, China
| | - Huaqing Liu
- Artificial Intelligence Innovation Center, Research Institute of Tsinghua, Pearl River Delta, China
| | - Xiang Liao
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, China
- Department of Pain Medicine and Shenzhen Municipal Key Laboratory for Pain Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, China
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Huang Z, Huang C, Wang Y, Wu Y, Guo C, Li W, Kong Q. Clinical Features, Risk Factors, and Prediction Nomogram for Primary Spinal Osteosarcoma: A Large-Cohort Retrospective Study. Global Spine J 2024; 14:930-940. [PMID: 36154721 PMCID: PMC11192120 DOI: 10.1177/21925682221129219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The goal of this study was to determine the clinical characteristics of patients with primary spinal osteosarcoma and to construct a practical clinical prediction model for patients to achieve an accurate prediction of overall survival. METHODS This study included 230 patients diagnosed between 2004-2015 from the Surveillance, Epidemiology, and End Results database. Independent risk factors were screened in the training set using Cox regression algorithms, and a prognostic model was developed. Internal and external validation sets were used to test the nomogram model's calibration, discrimination, and clinical utility. A risk classification system based on the nomogram was developed and validated. RESULTS Four independent prognostic factors were identified, and based on this a nomogram model was developed for predicting patient prognosis. The C-index of the training set was .737, while that of the validation set was .693. The time-varying area under the curve values was greater than .720 in both cohorts. The calibration curves proved that the prediction model has high prediction accuracy. The decision curve analysis showed that the nomogram is clinically useful. A risk classification system was established, which allows all patients to be divided into two different risk groups. CONCLUSIONS A nomogram and risk classification system was developed for patients with primary spinal osteosarcoma to accurately predict overall patient survival and achieve risk stratification of patient mortality. These tools are expected to play an important role in clinical practice, informing clinicians in making decisions.
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Affiliation(s)
- Zhangheng Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chao Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chuan Guo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weilong Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qingquan Kong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Salehi MA, Mohammadi S, Harandi H, Zakavi SS, Jahanshahi A, Shahrabi Farahani M, Wu JS. Diagnostic Performance of Artificial Intelligence in Detection of Primary Malignant Bone Tumors: a Meta-Analysis. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:766-777. [PMID: 38343243 PMCID: PMC11031503 DOI: 10.1007/s10278-023-00945-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 04/20/2024]
Abstract
We aim to conduct a meta-analysis on studies that evaluated the diagnostic performance of artificial intelligence (AI) algorithms in the detection of primary bone tumors, distinguishing them from other bone lesions, and comparing them with clinician assessment. A systematic search was conducted using a combination of keywords related to bone tumors and AI. After extracting contingency tables from all included studies, we performed a meta-analysis using random-effects model to determine the pooled sensitivity and specificity, accompanied by their respective 95% confidence intervals (CI). Quality assessment was evaluated using a modified version of Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) and Prediction Model Study Risk of Bias Assessment Tool (PROBAST). The pooled sensitivities for AI algorithms and clinicians on internal validation test sets for detecting bone neoplasms were 84% (95% CI: 79.88) and 76% (95% CI: 64.85), and pooled specificities were 86% (95% CI: 81.90) and 64% (95% CI: 55.72), respectively. At external validation, the pooled sensitivity and specificity for AI algorithms were 84% (95% CI: 75.90) and 91% (95% CI: 83.96), respectively. The same numbers for clinicians were 85% (95% CI: 73.92) and 94% (95% CI: 89.97), respectively. The sensitivity and specificity for clinicians with AI assistance were 95% (95% CI: 86.98) and 57% (95% CI: 48.66). Caution is needed when interpreting findings due to potential limitations. Further research is needed to bridge this gap in scientific understanding and promote effective implementation for medical practice advancement.
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Affiliation(s)
- Mohammad Amin Salehi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Soheil Mohammadi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran.
| | - Hamid Harandi
- School of Medicine, Tehran University of Medical Sciences, Pour Sina St, Keshavarz Blvd, Tehran, 1417613151, Iran
| | - Seyed Sina Zakavi
- School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Jahanshahi
- School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Jim S Wu
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
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Yeung CM, Bilsky M, Boland PJ, Vaynrub M. The Role of En Bloc Resection in the Modern Era for Primary Spine Tumors. Spine (Phila Pa 1976) 2024; 49:46-57. [PMID: 37732462 PMCID: PMC10750970 DOI: 10.1097/brs.0000000000004821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/27/2023] [Indexed: 09/22/2023]
Abstract
STUDY DESIGN A literature review. OBJECTIVE The aim of this review is to provide an overview of benign and malignant primary spine tumors and a balanced analysis of the benefits and limitations of (and alternatives to) surgical treatment with en bloc resection. SUMMARY OF BACKGROUND DATA Primary spine tumors are rare but have the potential to cause severe morbidity, either from the disease itself or as a result of treatment. The prognosis, goals, and treatment options vary significantly with the specific disease entity. Appropriate initial management is critical; inappropriate surgery before definitive treatment can lead to recurrence and may render the patient incurable, as salvage options are often inferior. METHODS We performed a comprehensive search of the PubMed database for articles relevant to primary spine neoplasms and en bloc spine surgery. Institutional review board approval was not needed. RESULTS Although Enneking-appropriate en bloc surgery can be highly morbid, it often provides the greatest chance for local control and/or patient survival. However, there is growing data to support modern radiotherapy as a feasible and less morbid approach to certain primary neoplasms that historically were considered radioresistant. CONCLUSIONS Choosing the optimal approach to primary spine tumors is complex. A comprehensive and up-to-date assessment of the evidence is required to guide patient care and to balance the often-competing goals of prolonging life and preserving quality of life.
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Affiliation(s)
- Caleb M. Yeung
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patrick J. Boland
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Max Vaynrub
- Department of Surgery, Orthopaedic Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Elsamadicy AA, Sayeed S, Sherman JJZ, Hengartner AC, Pennington Z, Hersh AM, Lo SFL, Shin JH, Mendel E, Sciubba DM. Racial disparities in the management and outcomes of primary osseous neoplasms of the spine: a SEER analysis. J Neurooncol 2024; 166:293-301. [PMID: 38225469 DOI: 10.1007/s11060-023-04557-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/27/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Primary osseous neoplasms of the spine, including Ewing's sarcoma, osteosarcoma, chondrosarcoma, and chordoma, are rare tumors with significant morbidity and mortality. The present study aims to identify the prevalence and impact of racial disparities on management and outcomes of patients with these malignancies. METHODS The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a cancer registry, was retrospectively reviewed to identify patients with Ewing's sarcoma, osteosarcoma, chondrosarcoma, or chordoma of the vertebral column or sacrum/pelvis. Study patients were divided into race-based cohorts: White, Black, Hispanic, and Other. Demographics, tumor characteristics, treatment variables, and mortality were assessed. RESULTS 2,415 patients were identified, of which 69.8% were White, 5.8% Black, 16.1% Hispanic, and 8.4% classified as "Other". Tumor type varied significantly between cohorts, with osteosarcoma affecting a greater proportion of Black patients compared to the others (p < 0.001). A lower proportion of Black and Other race patients received surgery compared to White and Hispanic patients (p < 0.001). Utilization of chemotherapy was highest in the Hispanic cohort (p < 0.001), though use of radiotherapy was similar across cohorts (p = 0.123). Five-year survival (p < 0.001) and median survival were greatest in White patients (p < 0.001). Compared to non-Hispanic Whites, Hispanic (p < 0.001) and "Other" patients (p < 0.001) were associated with reduced survival. CONCLUSION Race may be associated with tumor characteristics at diagnosis (including subtype, size, and site), treatment utilization, and mortality, with non-White patients having lower survival compared to White patients. Further studies are necessary to identify underlying causes of these disparities and solutions for eliminating them.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | | | - Andrew M Hersh
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
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9
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Ji H, Kong L, Wang Y, Hou Z, Kong W, Qi J, Jin Y. CD44 expression is correlated with osteosarcoma cell progression and immune infiltration and affects the Wnt/β-catenin signaling pathway. J Bone Oncol 2023; 41:100487. [PMID: 37287706 PMCID: PMC10242553 DOI: 10.1016/j.jbo.2023.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023] Open
Abstract
CD44 is associated with a variety of human diseases and plays a potential role in tumorigenesis, however, the mechanism of its role in osteosarcoma remains unclear. We analyzed the expression of CD44 in the Cancer Genome Atlas (TCGA) and genotype-tissue expression pan-cancer data and found that it was highly expressed in most tumors, including sarcoma. The expression of CD44 in osteosarcoma cell lines was higher than that in human osteoblast cell line in the results of the Western blot and Immunohistochemical staining assay. The results of colony formation assay and CCK 8 showed that CD44 improved the proliferation capacity of osteosarcoma cells, transwell assay and wound healing assay showed that CD44 improved the migration capacity of osteosarcoma cells. Further studies revealed that CD44 exerts its influence on the biological behavior of osteosarcoma cells through the Wnt/β-catenin signaling pathway. Since CD44 may be involved in the immune response, we analyzed the correlation between CD44 expression and immune cell infiltration in TCGA database using the previous cluster analyzer R software package, TIMER2.0 database and, GEPIA2 database, and found its involvement in the immune infiltration of osteosarcoma. Therefore, we believe that CD44 could be a potential target for the treatment of osteosarcoma patients and may be a candidate biomarker for immune infiltration-related prognosis.
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Affiliation(s)
- Hairu Ji
- Department of Pathology, Chengde Medical University, Chengde 067000, China
| | - Lingwei Kong
- Department of Traumatology and Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
| | - Yu Wang
- Department of Traumatology and Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
| | - Zhiping Hou
- Department of Pathology, Chengde Medical University, Chengde 067000, China
| | - Wei Kong
- Department of Pathology, Chengde Medical University, Chengde 067000, China
| | - Jiemin Qi
- Department of Pathology, Chengde Medical University, Chengde 067000, China
| | - Yu Jin
- Department of Traumatology and Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde 067000, China
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10
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Zhang Y, Hu J, Li T, Hao S, Wu X. Construction of a Diagnostic Model for Distinguishing Benign or Malignant Bone Cancer by Mining miRNA Expression Data. Biochem Genet 2023; 61:299-315. [PMID: 35861903 DOI: 10.1007/s10528-022-10259-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/18/2022] [Indexed: 01/24/2023]
Abstract
Bone tumor is a kind of rare cancer, the location of which is mainly in bone tissue as well as cartilage tissue. Bone tumor is mainly classified into benign and malignant types. The survival rate of patients with bone tumors can be considerably improved by early detection, and the danger of amputation caused by bone tumors can be greatly reduced. In this study, we first screened the top 25% serum miRNAs with the greatest variance in patients with malignant and benign bone tumor and healthy individuals. The expression of serum miRNAs in patients with bone tumor was then examined using unsupervised clustering and PCA, and the results revealed that the overall expression of serum miRNAs was ineffective in distinguishing patients with benign/malignant bone tumors. Subsequently, we screened 19 miRNA biomarkers that could be used to determine the benign/malignant bone tumor of patients by LASSO logistic regression. These genes were validated using ROC curves. Results showed that there were 11 miRNAs that could accurately distinguish benign/malignant bone tumor alone. These 11 miRNAs were, namely, hsa-miR-192-5p, hsa-miR-137, hsa-miR-142-3p, hsa-miR-155-3p, hsa-miR-1205, hsa-miR-1273a, hsa-miR-3187-3p, hsa-miR-1255b-2-3p, hsa-miR-1288-5p, hsa-miR-6836-5p, and hsa-miR-6862-5p. Next, we established a diagnostic model using logistic regression and validated the diagnostic model using ROC curves; the result of which showed that the model had good diagnostic efficacy. Then, we also verified that the diagnostic model established by these 11 miRNAs could distinguish patients with benign/malignant bone tumor using unsupervised clustering as well as PCA. Finally, by using qPCR, we validated the expression of 11 miRNAs in the serum of patients with malignant and benign bone tumors, as well as healthy volunteers. The results were consistent with the trend of miRNAs expression in public databases. In summary, we examined the differential expression of serum miRNAs in individuals with benign and malignant bone tumors and discovered 11 miRNA biomarkers that could be utilized to discriminate between the two.
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Affiliation(s)
- Yueming Zhang
- Department of Orthopedics, Area 3, Tangshan Gongren Hospital, No. 27 Wenhua Road, Lubei District, Tangshan, 063003, Hebei, China.
| | - Jianwei Hu
- Department of Orthopedics, Area 3, Tangshan Gongren Hospital, No. 27 Wenhua Road, Lubei District, Tangshan, 063003, Hebei, China
| | - Tao Li
- Department of Surgery, Tangshan Ninth Hospital, Tangshan, 063099, Hebei, China
| | - Shizhu Hao
- Department of Surgical Oncology, Area 1, Tangshan Gongren Hospital, Tangshan, 063003, Hebei, China
| | - Xiaotang Wu
- Shanghai Engineering Research Center of Pharmaceutical Translation, Shanghai, 200231, China
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11
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Hu P, Du S, Wei F, Zhai S, Zhou H, Liu X, Liu Z. Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh. Front Oncol 2022; 12:1065303. [PMID: 36601475 PMCID: PMC9806260 DOI: 10.3389/fonc.2022.1065303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Background Surgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs. Methods We performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status. Results The 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach (p < 0.05). Group A had a higher complication rate than group B (p < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%). Conclusions Total resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.
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Affiliation(s)
- Panpan Hu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Suiyong Du
- Department of Spine Surgery, 521 Hospital of Norinco Group, Xi’an, China
| | - Feng Wei
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China,*Correspondence: Feng Wei,
| | - Shuheng Zhai
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Hua Zhou
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Department of Orthopedics and Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
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12
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Costăchescu B, Niculescu AG, Iliescu BF, Dabija MG, Grumezescu AM, Rotariu D. Current and Emerging Approaches for Spine Tumor Treatment. Int J Mol Sci 2022; 23:15680. [PMID: 36555324 PMCID: PMC9779730 DOI: 10.3390/ijms232415680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Spine tumors represent a significant social and medical problem, affecting the quality of life of thousands of patients and imposing a burden on healthcare systems worldwide. Encompassing a wide range of diseases, spine tumors require prompt multidisciplinary treatment strategies, being mainly approached through chemotherapy, radiotherapy, and surgical interventions, either alone or in various combinations. However, these conventional tactics exhibit a series of drawbacks (e.g., multidrug resistance, tumor recurrence, systemic adverse effects, invasiveness, formation of large bone defects) which limit their application and efficacy. Therefore, recent research focused on finding better treatment alternatives by utilizing modern technologies to overcome the challenges associated with conventional treatments. In this context, the present paper aims to describe the types of spine tumors and the most common current treatment alternatives, further detailing the recent developments in anticancer nanoformulations, personalized implants, and enhanced surgical techniques.
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Affiliation(s)
- Bogdan Costăchescu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Adelina-Gabriela Niculescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Bogdan Florin Iliescu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Marius Gabriel Dabija
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
| | - Alexandru Mihai Grumezescu
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
- Academy of Romanian Scientists, Ilfov No. 3, 050044 Bucharest, Romania
| | - Daniel Rotariu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Prof. Dr. N. Oblu” Emergency Clinical Hospital, 700309 Iasi, Romania
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Jae-Min Park A, McDowell S, Mesfin A. Management of Chordoma of the Sacrum and Mobile Spine. JBJS Rev 2022; 10:01874474-202212000-00004. [PMID: 36639876 DOI: 10.2106/jbjs.rvw.22.00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
➢ Chordomas account for 1% to 4% of primary tumors of the spine and sacrum. ➢ En bloc resection is the preferred surgical treatment for the management of chordomas. ➢ Proton beam radiation is increasingly being used as a postoperative radiation modality for the treatment of chordomas.
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Affiliation(s)
- Andrew Jae-Min Park
- Department of Orthopedic Surgery and Physical Performance, University of Rochester School of Medicine & Dentistry, Rochester, New York
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14
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Lange N, Jörger AK, Ryang YM, Liesche-Starnecker F, Gempt J, Meyer B. Primary Bone Tumors of the Spine—Proposal for Treatment Based on a Single Centre Experience. Diagnostics (Basel) 2022; 12:diagnostics12092264. [PMID: 36140664 PMCID: PMC9498005 DOI: 10.3390/diagnostics12092264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed 92 patients receiving surgery for PBTs from 2007 to 2019 at our center. They were analyzed based on surgical management and the course of the disease. A total of 145 surgical procedures were performed (50 cervical, 46 thoracic, 28 lumbar, and 21 sacral). Complete tumor resection was achieved in 65%, of which 22% showed tumor recurrence during follow-up (mean time to recurrence 334 days). The five-year mortality rate was significantly lower after complete resection (3% versus 25% after subtotal resection). Most of the patients improved in their symptoms through surgery. Regarding the tumor entity, the most common PBTs were vertebral hemangiomas (20%), osteoid osteomas (15%), and chordomas (16%). The Enneking graduation system showed a good correlation with the risk of recurrence and mortality. Complete resection in PBTs increased survival rates and remains the method of choice. Thus, quality of life—especially with a higher extent of resection—should be considered.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
- Correspondence:
| | - Ann-Kathrin Jörger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany
| | | | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
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15
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Survival of Patients With Primary Osseous Malignancies of the Mobile Spine Is Associated With Access to "Standard Treatment" Protocols. J Am Acad Orthop Surg 2022; 30:841-850. [PMID: 35507547 DOI: 10.5435/jaaos-d-22-00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/17/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Malignancies of the mobile spine carry high morbidity and mortality. This study sought to examine factors associated with receipt of "standard" treatment and survival for patients with primary mobile spine tumors in the California Cancer Registry (CCR). METHODS The CCR (1988 to 2016) data were obtained for patients with primary tumors of the mobile spine and at least 1-year follow-up. Sacrum/pelvis tumors were excluded. Age at diagnosis, sex, race, neighborhood socioeconomic status, insurance, Charlson Comorbidity Index, histologic diagnosis, stage at diagnosis, and treatment at a National Cancer Institute-designated Cancer Center (NCICC) were collected. Multivariate analyses were done to identify factors associated with all-cause mortality and receipt of "standard" treatment. RESULTS Four hundred eighty-four patients (64% White, 56% low neighborhood socioeconomic status, and 36% privately insured) were included. Chordoma (37%) was the most common diagnosis. Only 16% had metastatic disease at presentation. Only 29% received treatment at an NCICC. Lower age, Charlson Comorbidity Index, less extensive stage of disease, and private insurance were associated with lower all-cause mortality (all P < 0.05). Medicaid/public insurance (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.13 to 2.41) and Medicare (HR, 1.80; 95% CI, 1.25 to 2.59) were associated with higher mortality compared with private insurance. Patients who received no known treatment (HR, 2.41; CI, 1.51 to 3.84) or treatment other than the "standard" (HR, 1.45; CI, 1.11 to 1.91) had higher mortality compared with those who received the standard protocols. A critical predictor of receiving the standard treatment protocol was being treated at an NCICC. If patients did not receive care at such institutions, they received optimal treatment only 40% of the time (HR, 0.5; P = 0.004). CONCLUSIONS Receipt of defined "standard treatment" protocols was associated with care received at an NCICC and lower all-cause mortality in patients with primary osseous malignancies of the mobile spine. Patients with public insurance are vulnerable to worse outcomes, regardless of age, disease burden, or receipt of standard treatment. LEVEL OF EVIDENCE III.
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Tong Y, Huang Z, Jiang L, Pi Y, Gong Y, Zhao D. Individualized assessment of risk and overall survival in patients newly diagnosed with primary osseous spinal neoplasms with synchronous distant metastasis. Front Public Health 2022; 10:955427. [PMID: 36072380 PMCID: PMC9441606 DOI: 10.3389/fpubh.2022.955427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/28/2022] [Indexed: 01/24/2023] Open
Abstract
Background The prognosis of patients with primary osseous spinal neoplasms (POSNs) presented with distant metastases (DMs) is still poor. This study aimed to evaluate the independent risk and prognostic factors in this population and then develop two web-based models to predict the probability of DM in patients with POSNs and the overall survival (OS) rate of patients with DM. Methods The data of patients with POSNs diagnosed between 2004 and 2017 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistics regression analyses were used to study the risk factors of DM. Based on independent DM-related variables, we developed a diagnostic nomogram to estimate the risk of DM in patients with POSNs. Among all patients with POSNs, those who had synchronous DM were included in the prognostic cohort for investigating the prognostic factors by using Cox regression analysis, and then a nomogram incorporating predictors was developed to predict the OS of patients with POSNs with DM. Kaplan-Meier (K-M) survival analysis was conducted to study the survival difference. In addition, validation of these nomograms were performed by using receiver operating characteristic (ROC) curves, the area under curves (AUCs), calibration curves, and decision curve analysis (DCA). Results A total of 1345 patients with POSNs were included in the study, of which 238 cases (17.70%) had synchronous DM at the initial diagnosis. K-M survival analysis and multivariate Cox regression analysis showed that patients with DM had poorer prognosis. Grade, T stage, N stage, and histological type were found to be significantly associated with DM in patients with POSNs. Age, surgery, and histological type were identified as independent prognostic factors of patients with POSNs with DM. Subsequently, two nomograms and their online versions (https://yxyx.shinyapps.io/RiskofDMin/ and https://yxyx.shinyapps.io/SurvivalPOSNs/) were developed. The results of ROC curves, calibration curves, DCA, and K-M survival analysis together showed the excellent predictive accuracy and clinical utility of these newly proposed nomograms. Conclusion We developed two well-validated nomograms to accurately quantify the probability of DM in patients with POSNs and predict the OS rate in patients with DM, which were expected to be useful tools to facilitate individualized clinical management of these patients.
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Affiliation(s)
- Yuexin Tong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhangheng Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Liming Jiang
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yangwei Pi
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yan Gong
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China
| | - Dongxu Zhao
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, China,*Correspondence: Dongxu Zhao
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Tang C, Wang D, Wu Y, Xu H, Zhang H. Surgery Has Positive Effects on Spinal Osteosarcoma Prognosis: A Population-Based Database Study. World Neurosurg 2022; 164:e367-e386. [PMID: 35504478 DOI: 10.1016/j.wneu.2022.04.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The treatment of osteosarcoma of the spine remains controversial. Our aim was to explore the treatment of patients with spinal osteosarcoma. METHODS We analyzed the data from 727 spinal osteosarcoma patients from the Surveillance, Epidemiology, and End Results database from 1973 to 2015. X-tile software was used to find the optimal cutoff values for age and economic income. The Kaplan-Meier estimator method was used to analyze overall survival and cancer-specific survival. Univariate and multivariate Cox analyses were used to identify the independent prognostic factors. Propensity score matching was used to reduce the possibility of selection bias. A logistic regression model was used to clarify the relevant factors affecting a patient's decision to undergo surgery. RESULTS Among 727 eligible spinal osteosarcoma patients, 370 (50.9%) had undergone surgery and 357 (49.1%) had not undergone surgery. Significant differences were found in the effects of patient age at diagnosis, Surveillance, Epidemiology, and End Results historical stage, and tumor grade on the patients' decision to undergo surgery (P < 0.05). Surgery was an independent prognostic factor for overall survival and cancer-specific survival of patients with spinal osteosarcoma. The same results were found after 1:1 propensity score matching. The surgery group had more favorable survival compared with the nonsurgery group. CONCLUSIONS Surgery can provide survival benefits for patients with osteosarcoma of the spine. The patients with spinal osteosarcoma who had undergone surgery experienced favorable survival benefits. Thus, surgery can be a suitable treatment for patients with spinal osteosarcoma.
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Affiliation(s)
- Chao Tang
- Orthopedic Department, People's Hospital of Putuo District, Tongji University School of Medicine, Shanghai, China; Pain Department, Pizhou City People's Hospital, Xuzhou Medical University, Xuzhou City, China
| | - Dongdong Wang
- Orthopedics Department, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuman Wu
- Fifth Clinical Medical College, Hubei University of Medicine, Hubei, China
| | - Hengyuan Xu
- Jiakou Community Health Service Center, Pizhou City People's Hospital, Xuzhou Medical University, Xuzhou City, China
| | - Hailong Zhang
- Orthopedic Department, People's Hospital of Putuo District, Tongji University School of Medicine, Shanghai, China.
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Li J, Wang X, Li Y, Cao Q, Bu Y, Cao H, Wang X. Pathological Clinical Analysis and Imaging Manifestations for Spinal Bone Tumors Based on Cement Injection. Appl Bionics Biomech 2022; 2022:2105332. [PMID: 35510043 PMCID: PMC9061064 DOI: 10.1155/2022/2105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
In order to explore the imaging manifestations and pathological characteristics of spine tumors, this article explores the clinical diagnosis and treatment methods through multi-sample case analysis with the support of imaging, and proposes a targeted treatment method that uses a special PVP needle with a beveled puncture surface for puncture. Moreover, this article uses the supporting PVP syringe for bone cement injection, develops a health status questionnaire, and adopts a scoring method for comprehensive assessment. The purpose of this article is to show that through the combination of preoperative radiotherapy and postoperative bracing, bone cement injection to treat vertebral tumors can immediately obtain satisfactory pain relief. Finally, through case analysis and image performance, we can see that the method proposed in this article has a certain effect.
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Affiliation(s)
- Jie Li
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Xu Wang
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Yongmin Li
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Qinhui Cao
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Yi Bu
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Hengcong Cao
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Xiaoqiang Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China 200000
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Worawongsakul R, Steinmeier T, Lin YL, Bauer S, Hardes J, Hecker-Nolting S, Dirksen U, Timmermann B. Proton Therapy for Primary Bone Malignancy of the Pelvic and Lumbar Region - Data From the Prospective Registries ProReg and KiProReg. Front Oncol 2022; 12:805051. [PMID: 35251976 PMCID: PMC8888414 DOI: 10.3389/fonc.2022.805051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE/OBJECTIVES Multimodality treatments together with local proton therapy (PT) are commonly used in unresectable primary bone malignancies in order to provide better tumor control rate while maintaining good feasibility. The aim of this study is to provide data on outcome of PT for the challenging cohort of pelvic and lumbar bone tumors. METHODS AND MATERIALS This retrospective study includes all patients with primary bone malignancy of the pelvis and lumbar spine receiving PT in our institution between May 2013 and December 2019 enrolled in the prospective registries KiProReg and ProReg collecting information on demographics, treatment, tumor characteristics, toxicities, and outcome. RESULTS Eighty-one patients were enrolled with a median age of 19.7 years (1.3-85.8). The median follow-up time was 27.5 months (1.2-83.2). The majority of patients was male (64.2%), ECOG status of 0-1 (75.2%), underwent only biopsy (50.6%), received chemotherapy (69.1%) and was assigned for definite PT (70.4%). The predominant tumor characteristics were as follows: Ewing's sarcoma histology (58%), negative nodal involvement (97.5%) and no metastasis at diagnosis (81.5%). Median maximal diameter of tumor was 8 cm (1.4-20). LC, EFS and OS rate were 76.5, 60, and 88.1% at two years and 72.9, 45.7, and 68.9% at three years, respectively. Age over 20 years was a significant negative factor for LC, EFS, and OS. Metastatic disease at initial diagnosis affected OS and ECOG status of 2-4 affected EFS only. Regarding 17 relapsed cases (21%), isolated distant relapse was the most common failure (46.9%) followed by local failure (40.6%). Eleven out of 14 evaluable patients relapsed within high-dose region of radiotherapy. Acute grade 3-4 toxicity was found in 41 patients (50.6%) and all toxicities were manageable. Late grade 3 toxicity was reported in 7 patients (10.4%) without any of grade 4. Most common higher grade acute and late side effects concerned hematologic and musculoskeletal toxicity. CONCLUSION Proton therapy resulted in good oncological outcomes when being part of the multimodality treatment for pelvic and lumbar primary bone malignancies. However, distant metastases and local failures within the high-dose region of radiotherapy are still a common issue. Acute and late toxicities of combined therapy were acceptable.
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Affiliation(s)
- Rasin Worawongsakul
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- Radiation Oncology Unit, Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- West German Cancer Centre Network, Essen, Germany
| | - Theresa Steinmeier
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- West German Cancer Centre Network, Essen, Germany
| | - Yi-Lan Lin
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- West German Cancer Centre Network, Essen, Germany
| | - Sebastian Bauer
- West German Cancer Centre Network, Essen, Germany
- Department of Medical Oncology, Sarcoma Center, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
| | - Jendrik Hardes
- West German Cancer Centre Network, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
- Department of Orthopedic Oncology, University Hospital Essen, Essen, Germany
| | - Stefanie Hecker-Nolting
- Pediatrics 5 (Oncology, Hematology, Immunology), Klinikum Stuttgart Olgahospital, Stuttgart, Germany
| | - Uta Dirksen
- West German Cancer Centre Network, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
- Pediatrics III (Hematology, Oncology, Immunology, Cardiology, Pulmonology), University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, Essen, Germany
- West German Cancer Centre Network, Essen, Germany
- German Cancer Consortium (DKTK), Essen, Germany
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20
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Primary Ewing sarcoma/peripheral primitive neuroectodermal tumors in the cranial bone and mobile spine: what is the difference? BMC Surg 2022; 22:4. [PMID: 34996420 PMCID: PMC8742462 DOI: 10.1186/s12893-021-01452-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/23/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary Ewing sarcoma (ES)/peripheral primitive neuroectodermal tumors (pPNETs) are aggressive bone tumors that rarely occur in the axial skeleton, including the cranial bone and mobile spine. The purpose of this study was to investigate whether there were any differences in patient characteristics, treatment strategies, and outcomes between patients with ES/pPNETs of the cranial bone and those with ES/pPNETs of the mobile spine. METHODS A retrospective study was performed on 33 patients with ES/pPNETs who had been surgically treated and pathologically confirmed at our institution between 2010 and 2020. Patient characteristics were compared using Fisher exact tests or independent t tests. Survival rates were estimated via Kaplan-Meier survival analysis and compared using log-rank tests. RESULTS Thirteen patients had ES/pPNETs of the cranial bone (39.4%), while 20 patients had ES/pPNETs of the mobile spine (60.6%). Patients with ES/pPNETs of the cranial bone had a younger mean age (14.8 vs 22.6 years; p = 0.047) and longer mean disease duration (2.5 vs 1.9 months; p = 0.008) compared with those of patients with ES/pPNETs of the mobile spine. Kaplan-Meier analysis showed that gross total resection (GTR) and radiotherapy resulted in a longer median survival time. The overall survival rates and progression-free survival rates of patients with ES/pPNETs of the cranial bone versus those of the mobile spine were not significantly different (p = 0.386 and p = 0.368, respectively). CONCLUSIONS Patients with ES/pPNETs of the cranial bone were younger compared to patients with ES/pPNETs of the mobile spine. There was no significant difference in the prognosis of patients with ES/pPNETs of the cranial bone versus those of the mobile spine. Taken together, our findings suggest that GTR and radiotherapy offer the best prognosis for improved long-term survival.
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Pennington Z, Ehresman J, Pittman PD, Ahmed AK, Lubelski D, McCarthy EF, Goodwin CR, Sciubba DM. Chondrosarcoma of the spine: a narrative review. Spine J 2021; 21:2078-2096. [PMID: 33971325 DOI: 10.1016/j.spinee.2021.04.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 02/03/2023]
Abstract
Chondrosarcoma is an uncommon primary bone tumor with an estimated incidence of 0.5 per 100,000 patient-years. Primary chondrosarcoma of the mobile spine and sacrum cumulatively account for less than 20% of all cases, most .commonly causing patients to present with focal pain with or without radiculopathy, or myelopathy secondary to neural element compression. Because of the rarity, patients benefit from multidisciplinary care at academic tertiary-care centers. Current standard-of-care consists of en bloc surgical resection with negative margins; for high grade lesions adjuvant focused radiation with ≥60 gray equivalents is taking an increased role in improving local control. Prognosis is dictated by lesion grade at the time of resection. Several groups have put forth survival calculators and epidemiological evidence suggests prognosis is quite good for lesions receiving R0 resection. Future efforts will be focused on identifying potential chemotherapeutic adjuvants and refining radiation treatments as a means of improving local control.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Mayo Clinic, Rochester, MN USA 55905; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287.
| | - Jeff Ehresman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ USA 85013.
| | - Patricia D Pittman
- Department of Neuropathology, Duke University School of Medicine, Durham, NC USA 27710
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - Edward F McCarthy
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC USA 27710
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA 21287; Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY USA 11030.
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22
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Price MJ, Ramos RDLG, Dalton T, McCray E, Pennington Z, Erickson M, Walsh KM, Yassari R, Sciubba DM, Goodwin AN, Goodwin CR. Insurance status as a mediator of clinical presentation, type of intervention, and short-term outcomes for patients with metastatic spine disease. Cancer Epidemiol 2021; 76:102073. [PMID: 34857485 DOI: 10.1016/j.canep.2021.102073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/16/2021] [Accepted: 11/16/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND It is well established that insurance status is a mediator of disease management, treatment course, and clinical outcomes in cancer patients. Our study assessed differences in clinical presentation, treatment course, mortality rates, and in-hospital complications for patients admitted to the hospital with late-stage cancer - specifically, metastatic spine disease (MSD), by insurance status. METHODS The United States National Inpatient Sample (NIS) database (2012-2014) was queried to identify patients with visceral metastases, metastatic spinal cord compression (MSCC) or pathological fracture of the spine in the setting of cancer. Clinical presentation, type of intervention, mortality rates, and in-hospital complications were compared amongst patients by insurance coverage (Medicare, Medicaid, commercial or unknown). Multivariable logistical regression and age sensitivity analyses were performed. RESULTS A total of 48,560 MSD patients were identified. Patients with Medicaid coverage presented with significantly higher rates of MSCC (p < 0.001), paralysis (0.008), and visceral metastases (p < 0.001). Patients with commercial insurance were more likely to receive surgical intervention (OR 1.43; p < 0.001). Patients with Medicaid < 65 had higher rates of prolonged length of stay (PLOS) (OR 1.26; 95% CI, 1.01-1.55; p = 0.040) while both Medicare and Medicaid patients < 65 were more likely to have non-routine discharges. In-hospital mortality rates were significantly higher for patients with Medicaid (OR 2.66; 95% CI 1.20-5.89; p = 0.016) and commercial insurance (OR 1.58; 95% CI 1.09-2.27;p = 0.013) older than 65. CONCLUSION Given the differing severity in MSD presentation, mortality rates, and rates of PLOS by insurance status, our results identify disparities based on insurance coverage.
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Affiliation(s)
- Meghan J Price
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Rafael De la Garza Ramos
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tara Dalton
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Edwin McCray
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Melissa Erickson
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kyle M Walsh
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrea N Goodwin
- Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
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Bădilă AE, Rădulescu DM, Niculescu AG, Grumezescu AM, Rădulescu M, Rădulescu AR. Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review. Cancers (Basel) 2021; 13:4229. [PMID: 34439383 PMCID: PMC8392383 DOI: 10.3390/cancers13164229] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
In the last decades, the treatment of primary and secondary bone tumors has faced a slow-down in its development, being mainly based on chemotherapy, radiotherapy, and surgical interventions. However, these conventional therapeutic strategies present a series of disadvantages (e.g., multidrug resistance, tumor recurrence, severe side effects, formation of large bone defects), which limit their application and efficacy. In recent years, these procedures were combined with several adjuvant therapies, with different degrees of success. To overcome the drawbacks of current therapies and improve treatment outcomes, other strategies started being investigated, like carrier-mediated drug delivery, bone substitutes for repairing bone defects, and multifunctional scaffolds with bone tissue regeneration and antitumor properties. Thus, this paper aims to present the types of bone tumors and their current treatment approaches, further focusing on the recent advances in new therapeutic alternatives.
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Affiliation(s)
- Adrian Emilian Bădilă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Dragoș Mihai Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Adrian Radu Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
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Jawad MU, Farhan S, Haffner MR, Le HV, Thorpe SW, Klineberg EO, Randall RL. Primary mobile vertebral column sarcomas: Prognostic factors vary by histologic subtypes. J Surg Oncol 2021; 124:635-645. [PMID: 34091907 DOI: 10.1002/jso.26530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 05/09/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Primary sarcomas originating from the mobile spine portends a particularly sinister outcome. Rarity of the disease process has resulted in inconsistent data due to small sample size and heterogeneity in patient selection and analytics. METHODS Surveillance, Epidemiology and End Result (SEER) database from 1975 to 2017 was queried to report incidence and survival data in 712 patients in the United States. Kaplan-Meier and Cox Regression were used to determine the prognostic factors affecting survival. RESULTS Incidence of spinal sarcoma was 0.019 per 100,000 persons in 2017 and has not significantly changed since 2000 (p > 0.05). Disease-specific 5-year survival for the entire cohort was 57%. Osteosarcoma has the worst 5-year survival (39%) and chondrosarcoma has the best 5-year survival (69%). Independent predictors of survival for the entire cohort included age, grade, and stage. Stage was an independent predictor of survival for every histologic subtype. Additional predictors of survival for spinal osteosarcoma, Ewing sarcoma, and chondrosarcoma included age, size, and grade, respectively. CONCLUSIONS The current study is an analysis of a population-based registry reporting incidence survival data for patients with sarcoma of mobile vertebral column. Survival and prognostic factors vary by histologic subtypes. There is lack of improvement in survival over the last three decades.
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Affiliation(s)
- Muhammad U Jawad
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Saif Farhan
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Max R Haffner
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Hai Van Le
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedic Surgery, University of California-Davis, Sacramento, California, USA
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Takayanagi A, Siddiqi I, Ghanchi H, Lischalk J, Vrionis F, Ratliff J, Bilsky M, Hariri OR. Radiolucent Carbon Fiber-Reinforced Implants for Treatment of Spinal Tumors-Clinical, Radiographic, and Dosimetric Considerations. World Neurosurg 2021; 152:61-70. [PMID: 34062294 DOI: 10.1016/j.wneu.2021.05.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
The management of spine tumors is multimodal and personalized to each individual patient. Patients often require radiation therapy after surgical fixation. Although titanium implants are used most commonly, they produce significant artifact, leading to decreased confidence in target-volume coverage and normal tissue sparing. Carbon-based materials have been found to have minimal effects on dose perturbation in postoperative radiation therapy and have shown biostability and biocompatibility that are comparable to titanium implants. Using the PubMed and Web of Sciences databases, we conducted a systematic review of carbon-based screw and rod fixation systems in the treatment of spinal tumors. We reviewed clinical studies regarding safety of spine fixation with carbon fiber-reinforced (CFR) implants and biomechanical studies, as well as radiation and dosimetric studies. The radiolucency of CFR-polyether ether ketone implants has the potential to benefit patients with spine tumor. Clinical studies have shown no increase in complications with implementation of CFR-polyether ether ketone implants, and these devices seem to have sufficient stiffness and pullout strength. However, further trials are necessary to determine if there is a clinically significant impact on local tumor control.
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Affiliation(s)
- Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Imran Siddiqi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA.
| | - Hammad Ghanchi
- Department of Neurosurgery, Riverside University Health Systems, Moreno Valley, California, USA
| | - Jonathan Lischalk
- Department of Radiation Oncology, Permutter Cancer Center, New York University Grossman School of Medicine, New York, New York, USA
| | - Frank Vrionis
- Department of Neurosurgery, Marcus Neuroscience Institute, Boca Raton, Boca Raton, Florida, USA
| | - John Ratliff
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Mark Bilsky
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Omid R Hariri
- Department of Neurological Surgery, Kaiser Permanente Orange County, Anaheim, California, USA
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26
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Pennington Z, Ehresman J, Elsamadicy AA, Shin JH, Goodwin CR, Schwab JH, Sciubba DM. Systematic review of charged-particle therapy for chordomas and sarcomas of the mobile spine and sacrum. Neurosurg Focus 2021; 50:E17. [PMID: 33932924 DOI: 10.3171/2021.2.focus201059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Long-term local control in patients with primary chordoma and sarcoma of the spine and sacrum is increasingly reliant upon en bloc resection with negative margins. At many institutions, adjuvant radiation is recommended; definitive radiation is also recommended for the treatment of unresectable tumors. Because of the high off-target radiation toxicities associated with conventional radiotherapy, there has been growing interest in the use of proton and heavy-ion therapies. The aim of this study was to systematically review the literature regarding these therapies. METHODS The PubMed, OVID, Embase, and Web of Science databases were queried for articles describing the use of proton, combined proton/photon, or heavy-ion therapies for adjuvant or definitive radiotherapy in patients with primary sarcoma or chordoma of the mobile spine and sacrum. A qualitative synthesis of the results was performed, focusing on overall survival (OS), progression-free survival (PFS), disease-free survival (DFS), and disease-specific survival (DSS); local control; and postradiation toxicities. RESULTS Of 595 unique articles, 64 underwent full-text screening and 38 were included in the final synthesis. All studies were level III or IV evidence with a high risk of bias; there was also significant overlap in the reported populations, with six centers accounting for roughly three-fourths of all reports. Five-year therapy outcomes were as follows: proton-only therapies, OS 67%-82%, PFS 31%-57%, and DFS 52%-62%; metastases occurred in 17%-18% and acute toxicities in 3%-100% of cases; combined proton/photon therapy, local control 62%-85%, OS 78%-87%, PFS 90%, and DFS 61%-72%; metastases occurred in 12%-14% and acute toxicities in 84%-100% of cases; and carbon ion therapy, local control 53%-100%, OS 52%-86%, PFS (only reported for 3 years) 48%-76%, and DFS 50%-53%; metastases occurred in 2%-39% and acute toxicities in 26%-48%. There were no studies directly comparing outcomes between photon and charged-particle therapies or comparing outcomes between radiation and surgical groups. CONCLUSIONS The current evidence for charged-particle therapies in the management of sarcomas of the spine and sacrum is limited. Preliminary evidence suggests that with these therapies local control and OS at 5 years are comparable among various charged-particle options and may be similar between those treated with definitive charged-particle therapy and historical surgical cohorts. Further research directly comparing charged-particle and photon-based therapies is necessary.
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Affiliation(s)
- Zach Pennington
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeff Ehresman
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aladine A Elsamadicy
- 2Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
| | - John H Shin
- 3Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - C Rory Goodwin
- 4Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and
| | - Joseph H Schwab
- 5Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel M Sciubba
- 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Sun C, Li S. PTHR1 in osteosarcoma: Specific molecular mechanisms and comprehensive functional perspective. J Cell Mol Med 2021; 25:3175-3181. [PMID: 33675132 PMCID: PMC8034476 DOI: 10.1111/jcmm.16420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
Osteosarcoma occurs largely in children and adolescents and is the most common primary malignant tumour of bone. Although surgical advances and neoadjuvant chemotherapy have made great strides in recent years, rates of local recurrence and lung metastasis remain high, with a plateau in overall survival during the past decade. It is thus urgent to explore the pathogenesis of osteosarcoma and identify potential therapeutic targets. Parathyroid hormone receptor 1 (PTHR1) belongs to the broad family of G protein–coupled receptors, binding both parathyroid hormone (PTH) and parathyroid hormone–related peptide (PTHrP, a paracrine factor). Previous studies have shown that in tissues and cells of osteosarcoma, expression of PTHR1 is markedly increased, correlating with aggressive biologic behaviour and a poor prognosis. PTHR1 expression also correlates closely with epigenetic regulation, transcriptional regulation, post‐translational modification and protein interaction. Herein, we have summarized the latest research on the role played by PTHR1 in progression of osteosarcoma, assessing its clinical utility as a novel biomarker and its therapeutic ramifications.
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Affiliation(s)
- Chaonan Sun
- Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Shenglong Li
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China.,Department of Tissue Engineering, Center of 3D Printing & Organ Manufacturing, School of Fundamental Sciences, China Medical University (CMU), Shenyang, China
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Wang J, Gong M, Xiong Z, Zhao Y, Xing D. Immune-related prognostic genes signatures in the tumor microenvironment of sarcoma. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:2243-2257. [PMID: 33892543 DOI: 10.3934/mbe.2021113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sarcomas are a heterogeneous group of malignant mesenchymal neoplasms. This study aimed to investigate the immune-related prognostic gene signatures in the tumor microenvironment of sarcoma. The RNA-sequencing data and clinical phenotype data of 260 sarcoma samples and two normal samples were downloaded from The Cancer Genome Atla (TCGA) database. Tumor purity and immune cells infiltration were evaluated by Estimation of Stromal and Immune cells in Malignant Tumors using Expression data (ESTIMATE) deconvolution algorithm. Differentially expressed genes (DEGs) were screened in high vs. low immune score groups. Survival analysis was performed using Kaplan-Meier curve with log-rank test. Tumor infiltrating of immune cells was analyzed by Tumor Immune Estimation Resource (TIMER). High immune score and ESTIMATE score were associated with favorable prognosis. A total of 623 immune DEGs were screened. The majority of these genes (532 genes accounting for 85% of the DEGs) were up-regulated, and these genes were significantly enriched in various immune related biological processed and pathways, such as neutrophil activation, T cell activation, antigen processing and presentation. A total of 146 prognosis-related immune DEGs, and seven hub genes were identified, including B2M, HLA-DRB1, HLA-DRA, HLA-E, LCK, HLA-DPA1, and VAV1. Survival analysis showed that high expression of these genes was associated with a favorable prognosis. There were negative correlations between the expression of these hub genes and tumor purity, while positive correlations between expression of these hub genes and f infiltration levels of B cells, CD4+ T cells, CD8+ T cells, neutrophils, macrophages and dendritic cells. These results help to stratify patients with different immune subtypes and help to design immunotherapy strategies for these patients in sarcoma.
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Affiliation(s)
- Jun Wang
- Department of Orthopedics and Trauma, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, China
| | - Mingzhi Gong
- Department of Orthopedics and Trauma, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, China
| | - Zhenggang Xiong
- Department of Orthopedics and Trauma, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, China
| | - Yangyang Zhao
- Department of Orthopedics and Trauma, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, China
| | - Deguo Xing
- Department of Orthopedics and Trauma, The Second Hospital of Shandong University, No. 247 Beiyuan Street, Jinan, 250033, China
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Malik AT, Alexander J, Khan SN, Scharschmidt TJ. Has the Affordable Care Act Been Associated with Increased Insurance Coverage and Early-stage Diagnoses of Bone and Soft-tissue Sarcomas in Adults? Clin Orthop Relat Res 2021; 479:493-502. [PMID: 32805094 PMCID: PMC7899708 DOI: 10.1097/corr.0000000000001438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/08/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of bone and soft-tissue sarcomas can be costly, and therefore, it is not surprising that insurance status of patients is a prognostic factor in determining overall survival. Furthermore, uninsured individuals with suspected bone and/or soft-tissue masses routinely encounter difficulty in obtaining access to basic healthcare (such as office visits, radiology scans), and therefore are more likely to be diagnosed with later stages at presentation. The Patient Protection and Affordable Care Act (ACA) mandate of 2010 aimed to increase access to care for uninsured individuals by launching initiatives, such as expanding Medicaid eligibility, subsidizing private insurance, and developing statewide mandates requiring individuals to have a prescribed minimum level of health insurance. Although prior reports have demonstrated that the ACA increased both coverage and the proportion of early-stage diagnoses among patients with common cancers (including breast, colon, prostate, and lung), it is unknown whether similar improvements have occurred for patients with bone and soft-tissue sarcomas. Understanding changes in insurance coverages and stage at diagnosis of patients with bone and soft-tissue sarcomas would be paramount in establishing policies that will ensure orthopaedic cancer care is made equitable and accessible to all. QUESTIONS/PURPOSES (1) Has the introduction of the ACA been associated with changes in insurance coverage for adult patients with newly diagnosed bone and soft-tissue sarcomas? (2) Did the introduction of health reforms under the ACA lead to an increased proportion of sarcoma diagnoses occurring at earlier disease stages? METHODS The 2007 to 2015 Surveillance, Epidemiology and End Results database was queried using International Classification of Diseases for Oncology codes for primary malignant bone tumors of the upper and lower extremity (C40.0 to C40.3), unspecified or other overlapping bone, articular cartilage, and joint and/or ribs, sternum, or clavicle (C40.8 to C40.9, C41.3, and C41.8 to C41.9), vertebral column (C41.2), pelvis (C41.4, C41.8, and C41.9), and soft-tissue sarcomas of the upper or lower extremity and/or pelvis (C49.1, C49.2, and C49.5). A total of 15,287 patients with newly diagnosed cancers were included, of which 3647 (24%) were malignant bone tumors and 11,640 (76%) were soft-tissue sarcomas. The study sample was divided into three cohorts according to specified time periods: pre-ACA from 2007 to 2010 (6537 patients), pre-Medicaid expansion from 2011 to 2013 (5076 patients), and post-Medicaid expansion from 2014 to 2015 (3674 patients). The Pearson chi square tests were used to assess for changes in the proportion of Medicaid and uninsured patients across the specified time periods: pre-ACA, pre-expansion and post-expansion. A differences-in-differences analysis was also performed to assess changes in insurance coverage for Medicaid and uninsured patients among states that chose to expand Medicaid coverage in 2014 under the ACA's provision versus those who opted out of Medicaid expansion. Since the database switched to using the American Joint Commission on Cancer (AJCC) 7th edition staging system in 2010, linear regression using data only from 2010 to 2015 was performed that assessed changes in cancer stage at diagnosis from 2010 to 2015 alone. After stratifying by cancer type (bone or soft-tissue sarcoma), Pearson chi square tests were used to assess for changes in the proportion of patients who were diagnosed with early, late, and unknown stage at presentation before Medicaid expansion (2011-2013) and after Medicaid expansion (2014-2015) among states that chose to expand versus those who did not. RESULTS After stratifying by time cohorts: pre-ACA (2007 to 2010), pre-expansion (2011 to 2013) and post-expansion (2014 to 2015), we observed that the most dramatic changes occurred after Medicaid eligibility was expanded (2014 onwards), with Medicaid proportions increasing from 12% (pre-expansion, 2011 to 2013) to 14% (post-expansion, 2014 to 2015) (p < 0.001) and uninsured proportions decreasing from 5% (pre-expansion, 2011 to 2013) to 3% (post-expansion, 2014 to 2015) (p < 0.001). A differences-in-differences analysis that assessed the effect of Medicaid expansion showed that expanded states had an increase in the proportion of Medicaid patients compared with non-expanded states, (3.6% [95% confidence interval 0.4 to 6.8]; p = 0.03) from 2014 onwards. For the entire study sample, the proportion of early-stage diagnoses (I/II) increased from 56% (939 of 1667) in 2010 to 62% (1137 of 1840) in 2015 (p = 0.003). Similarly, the proportion of unknown stage diagnoses decreased from 11% (188 of 1667) in 2010 to 7% (128 of 1840) in 2015 (p = 0.002). There was no change in proportion of late-stage diagnoses (III/IV) from 32% (540 of 1667) in 2010 to 31% (575 of 1840) in 2015 (p = 0.13). CONCLUSION Access to cancer care for patients with primary bone or soft-tissue sarcomas improved after the ACA was introduced, as evidenced by a decrease in the proportion of uninsured patients and corresponding increase in Medicaid coverage. Improvements in coverage were most significant among states that adopted the Medicaid expansion of 2014. Furthermore, we observed an increasing proportion of early-stage diagnoses after the ACA was implemented. The findings support the preservation of the ACA to ensure cancer care is equitable and accessible to all vulnerable patient populations. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Azeem Tariq Malik
- A. T. Malik, J. Alexander, S. N. Khan, T. J. Scharschmidt, The James Cancer Hospital and Solove Research Institute, the Ohio State University Wexner Medical Center, Columbus, OH, USA
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Meazza C, Luksch R, Luzzati A. Managing axial bone sarcomas in childhood. Expert Rev Anticancer Ther 2021; 21:747-764. [PMID: 33593222 DOI: 10.1080/14737140.2021.1891886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Axial osteosarcoma and Ewing sarcoma are rare, aggressive neoplasms with a worse prognosis than with tumors involving the extremities because they are more likely to be associated with larger tumor volumes, older age, primary metastases, and a poor histological response to chemotherapy. The 5-year OS rates are reportedly in the range of 18-41% for axial osteosarcoma, and 46-64% for Ewing sarcoma.Area covered: The treatment of axial bone tumors is the same as for extremity bone tumors, and includes chemotherapy, surgery and/or radiotherapy.Expert opinion: Local treatment of axial tumors is particularly difficult due to their proximity to neurological and vascular structures, which often makes extensive and en bloc resections impossible without causing significant morbidity. The incidence of local relapse is consequently high, and this is the main issue in the treatment of these tumors. Radiotherapy is an option in the case of surgical resections with close or positive margins, as well as for inoperable tumors. Delivering high doses of RT to the spinal cord can be dangerous. Given the complexity and rarity of these tumors, it is essential for this subset of patients to be treated at selected reference institutions with specific expertise and multidisciplinary skills.
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Affiliation(s)
- Cristina Meazza
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Roberto Luksch
- Pediatric Oncology Unit, Medical Oncology and Emathology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milano, Italy
| | - Alessandro Luzzati
- Orthopedic Oncology and Spinal Reconstruction Surgery, Orthopedic Oncology Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Konieczkowski DJ, DeLaney TF, Yamada YJ. Radiation Strategies for Spine Chordoma: Proton Beam, Carbon Ions, and Stereotactic Body Radiation Therapy. Neurosurg Clin N Am 2020; 31:263-288. [PMID: 32147017 DOI: 10.1016/j.nec.2019.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Surgery alone provides suboptimal local control of spine and sacral chordomas. Radiotherapy (RT) may improve local control in patients undergoing surgery and be used as definitive-intent treatment in patients not undergoing surgery. Although conventional-dose RT is inadequate for these radioresistant tumors, newer techniques allow treatment of the tumor to higher, more effective doses while limiting spinal cord dose to safe levels. The best local control is achieved when RT is delivered in the primary setting; RT dose is a critical determinant of local control. RT should be considered for all spine and sacral chordoma patients.
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Affiliation(s)
- David J Konieczkowski
- Harvard Radiation Oncology Program, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Yoshiya Josh Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Abstract
STUDY DESIGN Case series. OBJECTIVE For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE 5.
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Zhang Y, Ai F, Fu S, Li K, Xia H, Wu Z, Ma X. [An application of posterior cervical and transoral approaches to treating primary malignant osseous tumors in craniovertebral junction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1149-1157. [PMID: 32929909 DOI: 10.7507/1002-1892.202001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective To investigate the surgical method for primary malignant osseous tumors in the craniovertebral junction (CVJ) and its effectiveness. Methods The clinical data of 7 patients with primary malignant osseous spinal tumors in CVJ, which collected between September 2010 and April 2019, were retrospectively analyzed. There were 5 males and 2 females, aged 23 to 75 years (median, 56 years). All patients were diagnosed as chordoma in 4 cases, plasmacytoma in 2 cases, and fibrosarcoma in 1 case. The disease duration ranged from 0.7 to 36.0 months, with an average of 12.2 months. Lesion location: 1 case of C 0, 1, 3 cases of C 2, 1 case of C 1, 2, 1 case of C 2, 3, and 1 case of C 0-2. Preoperative visual analogue scale (VAS) score was 6.7±2.1, the Japanese Orthopaedic Association (JOA) score was 15.6±2.4. According to American Society of Spinal Cord Injury (ASIA) grading system, there was 1 case of grade C, 1 case of grade D, and 5 cases of grade E. According to Enneking stage of spinal malignant tumor, there was 1 case of stage ⅠB, 2 cases of stage ⅡB, and 4 cases of stage Ⅲ. According to Weinstein-Boriani-Biagini (WBB) stage, there was 1 case of 5-8/A-D, 1 case of 4-9/A-D, 1 case of 6-7/B-D, 1 case of 6-7/A-D, 2 cases of 1-12/A-D, and 1 case of 3-10/A-D. All these patients were treated with tumor extended resection, bone graft fusion, and internal fixation via posterior cervical approach, as well as tumor (stage Ⅰ or stage Ⅱ) boundary resection via transoral or submandibular approach. Meanwhile, anterior reconstructive fusion was procedured with bone grafting Cage needed to place the internal fixation. Results The operation time was 307-695 minutes (mean, 489.57 minutes), and the intraoperative blood loss was 400-2 000 mL (mean, 1 107.14 mL). There was no intraoperative injury in vertebral artery and spinal cord or any related postoperative complications, including incision infection, intracranial infection, and pulmonary infection. All the patients were followed up 3-57 months (mean, 21 months). Postoperative X-ray film and CT showed that the internal fixation screw was firm and in a satisfactory position, and the bone graft was fused at 3-6 months after operation. Symptoms such as neck pain, limb numbness, and fatigue relieved to different degrees after operation. At 3 months after operation, the VAS score improved to 1.7±0.8 ( t=7.638, P=0.000); while the JOA score improved to 16.1±1.5, but no significant difference was found when compared with preoperative score ( t=1.549, P=0.172). According to ASIA grading system, 1 patient with grade C had upgraded to grade D after operation, while the remaining patients had no change. There were 4 cases of recurrence after operation, in which those patients were with high malignancy of tumors before the first surgery. Their tumors also affected a wide range of slope or surrounding soft tissues and could not be completely removed. Among the 4 cases, 1 patient underwent transoral tumor removal operation again, while the other 3 cases gave up further treatment. There was no recurrence among the remaining 3 cases. Conclusion Primary malignant osseous tumors in the CVJ can be completely exercised via means of trabsoral or submandibular approach. Meanwhile the anterior reconstruction can be achieved by placing special Cage specimen. These two methods together with postoperative adjuvant treatments such as radiotherapy and chemotherapy can improve the survival time of patients and reduce tumor recurrence.
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Affiliation(s)
- Yu Zhang
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Fuzhi Ai
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Suochao Fu
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Keke Li
- Department of Spinal Surgery, Huaxin Orthopaedic Hospital, Guangzhou Guangdong, 510100, P.R.China
| | - Hong Xia
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Zenghui Wu
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
| | - Xiangyang Ma
- Department of Orthopedics, General Hospital of Southern Theatre Command of Chinese PLA, Guangzhou Guangdong, 510010, P.R.China
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Chehrassan M, Ebrahimpour A, Sadighi M, Looha MA, Rad SB, Akbari ME. Epidemiologic trend of mobile spine and sacrum chordoma: A National population-based study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:226-231. [PMID: 33100773 PMCID: PMC7546048 DOI: 10.4103/jcvjs.jcvjs_109_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction: Chordoma is a rare sarcoma of the axial skeleton. The incidence of this tumor is different between races. To understand the epidemiologic characteristic and due to rarity of this pathology, large number of cases should be evaluated through national data registries. Materials and Methods: All pathologically confirmed cases of chordoma were derived from the Iran National Cancer Registry. Descriptive analysis was performed to extract age-standardized and age-specific incidence rates. Data regarding tumor location and chordoma subtypes were derived and analyzed. Results: One hundred twenty-two cases of chordoma including 80 male and 42 female were identified. One hundred seven cases of nonotherwise specified chordoma, 14 chondroid chordoma, and one dedifferentiated chordoma were detected. The age-standardized incidence rate (ASIR) of chordoma was 0.28. Chordoma of the sacrum composed 67.2% of cases. The mean survival time was 4.5 years. Conclusion: Epidemiology characteristic of chordoma in Iran is similar to other studies; however, the total ASIR was lower and the incidence in sacrum is nearly twice respect to the mobile spine. While men affected by sacral chordoma in relatively older age, the female patients had higher mean age in case of mobile spine involvement. The survival rate of chordoma is significantly lower in comparison with other studies.
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Affiliation(s)
- Mohammadreza Chehrassan
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Ebrahimpour
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sadighi
- Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Azizmohammad Looha
- Department of Biostatics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saber Barazandeh Rad
- Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Boriani S, Pipola V, Cecchinato R, Ghermandi R, Tedesco G, Fiore MR, Dionisi F, Gasbarrini A. Composite PEEK/carbon fiber rods in the treatment for bone tumors of the cervical spine: a case series. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3229-3236. [DOI: 10.1007/s00586-020-06534-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
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Wang J, Li D, Yang R, Tang X, Yan T, Guo W. Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours. INTERNATIONAL ORTHOPAEDICS 2020; 44:1841-1851. [DOI: 10.1007/s00264-020-04641-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
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Lazarides AL, Kerr DL, Dial BL, Steele JR, Lane WO, Blazer DG, Brigman BE, Mendoza-Lattes S, Erickson MM, Eward WC. Does facility volume influence survival in patients with primary malignant bone tumors of the vertebral column? A comparative cohort study. Spine J 2020; 20:1106-1113. [PMID: 32145357 DOI: 10.1016/j.spinee.2020.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Facility volume has been correlated with survival in many cancers. This relationship has not been established in primary malignant bone tumors of the vertebral column (BTVC). PURPOSE To investigate whether facility patient volume is associated with overall survival in patients with primary malignant BTVCs. STUDY DESIGN Retrospective comparative cohort. PATIENT SAMPLE Adult patients with chordomas, chondrosarcomas, or osteosarcomas of the mobile spine. OUTCOME MEASURES Five-year survival. METHODS We retrospectively analyzed 733 patients with primary malignant BTVCs in the national cancer database from 2004 through 2015. Univariate and multivariate analyses were used to correlate specific outcome measures with facility volume. Volume was stratified based on cumulative martingale residuals to determine the inflection point of negative to positive impact on survival based on the patient cohort. Long-term survival was compared between patients treated at high and low volume using the Kaplan-Meier method. Only patients with malignant primary tumors were considered eligible for inclusion; patients with incomplete treatment data or benign tumors were excluded. RESULTS Patients treated at high-volume centers (HVCs) were younger (p=.0003) and more likely to be insured (p<.0001). There were no significant differences in tumor characteristics. Patients treated at high-volume facilities had improved 5-year survival of 71% versus 58% at low-volume centers (p<.0001). Patients treated at HVCs were more likely to receive surgical treatment (91% vs. 80%, p<.0001); if surgery was performed, they were more likely to undergo an en bloc resection (48% vs. 30%, p<.0001). However, there were no differences in margin status or utilization of radiotherapy or chemotherapy between HVCs and low-volume centers. In a multivariate analysis, facility volume was independently associated with improved survival overall (HR 0.75 [0.58-0.97], p=.03). CONCLUSIONS Primary malignant BTVCs are rare, even for HVCs. Despite this, patient survival was significantly improved when treatment was performed at HVCs.
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Affiliation(s)
| | - David L Kerr
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian L Dial
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John R Steele
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Whitney O Lane
- Department of General Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dan G Blazer
- Department of General Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brian E Brigman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Melissa M Erickson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - William C Eward
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Wei F, Li Z, Liu Z, Liu X, Jiang L, Yu M, Xu N, Wu F, Dang L, Zhou H, Li Z, Cai H. Upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:332. [PMID: 32355776 PMCID: PMC7186708 DOI: 10.21037/atm.2020.03.32] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Reconstruction following resection of the primary tumors of the upper cervical spine is challenging, and conventional internal implants develop complications in this region. 3D printing, also known as additive manufacturing, can produce patient-specific porous implants in a particular shape for bone defect reconstruction. This study aimed to describe the clinical outcomes of upper cervical spine reconstruction using customized 3D-printed vertebral body in 9 patients with primary tumors involving C2. Methods Patients with primary tumors involving C2 who were treated in our institution between July 2014 and November 2018 were enrolled. A two-stage intralesional spondylectomy was performed using the posterior-anterior approach. Anterior reconstruction was accomplished using a customized 3D-printed vertebral body, which was fabricated by successive layering of melted titanium alloy powder using electron beam melting. No bone graft was used. Results Nine patients (2 males and 7 females) were included in the study with a mean age of 31.4 years (12 to 59 years). Seven patients demonstrated tumors located in C2 and 2 showed involvement of C2 and C3. During a mean follow-up of 28.6 months (range, 12–42 months), 1 patient died of systemic metastasis and 1 had local tumor recurrence, the other 7 patients were alive and functional in their daily living until the last follow-up without evidence of disease. The 3D-printed vertebral bodies were all stable with no sign of displacement or subsidence, evidence of implant osseointegration was observed on the imaging studies. For the posterior instrumentation systems, no screw loosening or rod breakage was found. Conclusions Spinal reconstruction in the upper cervical region using customized 3D-printed vertebral body is reliable. The tailored shape matching with the contact surfaces and the porous structure conductive to osseointegration provide both short- and long-term stability to the implant.
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Affiliation(s)
- Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhehuang Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zhongjun Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Miao Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Nanfang Xu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Fengliang Wu
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Lei Dang
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Hua Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Zihe Li
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
| | - Hong Cai
- Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China
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Wang D, Zhang P, Xu X, Wang J, Wang D, Peng P, Zheng C, Meng QJ, Yang L, Luo Z. Knockdown of cytokeratin 8 overcomes chemoresistance of chordoma cells by aggravating endoplasmic reticulum stress through PERK/eIF2α arm of unfolded protein response and blocking autophagy. Cell Death Dis 2019; 10:887. [PMID: 31767864 PMCID: PMC6877560 DOI: 10.1038/s41419-019-2125-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022]
Abstract
Chordoma is a malignant primary osseous spinal tumor with pronounced chemoresistance. However, the mechanisms of how chordoma cells develop chemoresistance are still not fully understood. Cytokeratin 8 (KRT8) is a molecular marker of notochordal cells, from which chordoma cells were believed to be originated. In this study, we showed that either doxorubicin or irinotecan promoted KRT8 expression in both CM319 and UCH1 cell lines, accompanied by an increased unfolded protein response and autophagy activity. Then, siRNA-mediated knockdown of KRT8 chemosensitized chordoma cells in vitro. Mechanistic studies showed that knockdown of KRT8 followed by chemotherapy aggravated endoplasmic reticulum stress through PERK/eIF2α arm of unfolded protein response and blocked late-stage autophagy. Moreover, suppression of the PERK/eIF2α arm of unfolded protein response using PERK inhibitor GSK2606414 partially rescued the apoptotic chordoma cells but did not reverse the blockage of the autophagy flux. Finally, tumor xenograft model further confirmed the chemosensitizing effects of siKRT8. This study represents the first systematic investigation into the role of KRT8 in chemoresistance of chordoma and our results highlight a possible strategy of targeting KRT8 to overcome chordoma chemoresistance.
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Affiliation(s)
- Di Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Peiran Zhang
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, 710032, China
| | - Xiaolong Xu
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Jianhui Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Dong Wang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Pandi Peng
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
- Medical Research Institute, Northwestern Polytechnical University, Xi'an, 710032, China
| | - Chao Zheng
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Qing-Jun Meng
- Wellcome Centre for Cell Matrix Research, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Liu Yang
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
- Medical Research Institute, Northwestern Polytechnical University, Xi'an, 710032, China.
| | - Zhuojing Luo
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China.
- Medical Research Institute, Northwestern Polytechnical University, Xi'an, 710032, China.
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