Clinical Significance of Preoperative CT and MR Imaging Findings in the Prediction of Postoperative Recurrence of Spinal Giant Cell Tumor of Bone

Feasibility of ADC histogram analysis for predicting of postoperative recurrence in aggressive spinal tumors

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.

En-bloc resection for spinal giant cell tumors: superior outcomes-a comprehensive meta-analysis and trial sequential analysis

Spinal giant cell tumors (GCTs) management primarily involves surgical resection; however, the optimal surgical approach continues to be a subject of debate. This study aims to comprehensively compare the efficacy of en-bloc resection with that of control resection techniques, specifically intralesional curettage and piecemeal resection, in the treatment of spinal GCTs. A comprehensive search of English databases, including the Cochrane Library, Embase, PubMed, Scopus, and Web of Science, as well as Chinese databases such as the National Knowledge Infrastructure (CNKI), Chongqing VIP (VIP), and Wan Fang, was conducted up to January 2024. This search identified twelve studies encompassing 492 participants. The meta-analysis indicated that en-bloc resection significantly reduces recurrence rates (OR = 0.27, 95% CI: 0.15-0.47, P < 0.00001) and mortality (OR = 0.16, 95% CI: 0.03-0.88, P = 0.04) when compared to control resection techniques. Notably, en-bloc resection demonstrated superior performance over control methods in both 1-year and 5-year relapse-free survival (RFS) rates (P = 0.001 and P < 0.00001, respectively), as well as in overall RFS (HR = 0.27, 95% CI: 0.08-0.91; P = 0.04). Despite its advantages, en-bloc excision was associated with a higher overall complication rate (P = 0.01). Furthermore, trial sequential analysis (TSA) suggests that the current sample size is inadequate to draw definitive conclusions, thereby underscoring the necessity for further investigations. En-bloc resection shows significant advantages over control resection techniques in reducing recurrence rates, mortality, and improving RFS. However, the higher complication rates and TSA findings stress the need for more high-quality studies to verify the benefits and safety of en-bloc resection in spinal GCT treatment.

Efficacy and safety of en-bloc resection versus debulking for spinal tumor: a systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to consolidate the existing evidence regarding the comparison between en-bloc resection surgery and debulking surgery for spinal tumors, including both primary and metastatic tumors.

MATERIALS AND METHODS

The databases of PubMed, Embase, Cochrane database, Web of Science, Scopus, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (VIP), and Wan Fang Database was carried out and included all studies that directly compared en-bloc resection surgery with debulking surgery for spinal tumors in patients through March 2024. The primary outcomes included recurrence rate, postoperative metastasis rate, mortality rate, overall survival (OS), recurrence-free survival (RFS), complication, and so on. The statistical analysis was conducted using Review Manager 5.3.

RESULTS

We systematically reviewed 868 articles and included 27 studies involving 1135 patients who underwent either en-bloc resection surgery (37.89%) or debulking surgery (62.11%). Our meta-analysis demonstrated significant advantages of en-bloc resection over debulking surgery. Specifically, the en-bloc resection group had a lower recurrence rate (OR = 0.19, 95%CI: 0.13-0.28, P < 0.00001), lower postoperative metastasis rate (P = 0.002), and lower mortality rate (P < 0.00001). Additionally, en-bloc resection could improve OS and RFS (HR = 0.45, 95%CI: 0.32-0.62, P < 0.00001 and HR = 0.37, 95%CI: 0.17-0.80, P = 0.01, respectively). However, en-bloc resection required longer operative times and was associated with a higher overall complication rate compared to debulking surgery (P = 0.0005 and P < 0.00001, respectively).

CONCLUSION

The current evidence indicates that en-bloc surgical resection can effectively control tumor recurrence and mortality, as well as improve RFS and OS for patients with spinal tumors. However, it is crucial not to overlook the potential risks of perioperative complications. Ultimately, these findings should undergo additional validation through multi-center, double-blind, and large-scale randomized controlled trials (RCTs).

Tumor Growth Rate in Spinal Giant Cell Tumors of Bone and Association With the Immune Microenvironment and Denosumab Treatment Responsiveness: A Multicenter Study

BACKGROUND

Currently, little is known about the prognostic value of tumor growth rate (TGR) in spinal giant cell tumors of bone (GCTB).

OBJECTIVE

To investigate the correlation of TGR with clinicopathological features, immune microenvironment, prognosis, and response to denosumab treatment of spinal GCTB.

METHODS

A total of 128 patients with spinal GCTB treated at 5 centers from 2011 to 2021 were included. TGR was assessed by 2 independent neuroradiologists using at least 2 preoperative thin-section magnetic resonance imaging scans at a minimum interval of 2 months. Immunohistochemistry was used to assess tumor-infiltrating lymphocyte subtypes for CD3, CD4, CD8, CD20, PD-1, PD-L1, and Foxp3. Then, these parameters were analyzed for their associations with patient outcomes (progression-free survival and overall survival), clinicopathological features, and denosumab treatment responsiveness.

RESULTS

High TGR predicted both poor progression-free survival and overall survival (both P < .001). In addition, TGR was associated with postoperative neurological dysfunction ( P < .001), Enneking staging ( P = .016), denosumab treatment responsiveness ( P = .035), and the number of CD3 + ( P < .001), PD-1 + ( P = .009), PD-L1 + ( P < .001), and FoxP3 + tumor-infiltrating lymphocyte ( P = .02). Importantly, TGR outperformed the traditional Enneking, Campanacci, and American Joint Committee on Cancer staging systems in predicting the clinical outcomes of spinal GCTB.

CONCLUSION

These data support the use of TGR as a reliable predictive tool for clinically relevant outcomes and response to denosumab therapy of spinal GCTB, which may be helpful in guiding prognostic risk stratification and therapeutic optimization of patients.