Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma

Complications and local recurrence of chondrosarcoma and chordoma treated by total tumor resection in thoracic and lumbar spine

BACKGROUND

En bloc resection of spinal tumors is challenging and associated with a high incidence of complications; however, it offers the potential to reduce the risk of recurrence when a wide margin is achieved. This research aims to investigate the safety and efficacy of en bloc resection in treating thoracic and lumbar chondrosarcoma/chordoma.

METHODS

Data from patients diagnosed with chondrosarcoma and chordoma in the thoracic or lumbar region, who underwent total en bloc or piecemeal resection at our institution over a 7-year period, were collected and regularly followed up. The study analyzed overall perioperative complications and compared differences in complications and local tumor recurrence between the two surgical methods.

RESULTS

Seventeen patients were included, comprising 12 with chondrosarcoma and 5 with chordoma. Among them, 5 cases underwent intralesional piecemeal resection, while the remaining 12 underwent planned en bloc resection. The average surgical time was 684 min (sd = 287), and the mean estimated blood loss was 2300 ml (sd = 1599). Thirty-five complications were recorded, with an average of 2.06 perioperative complications per patient. 82% of patients (14/17) experienced at least one perioperative complication, and major complications occurred in 64.7% (11/17). Five patients had local recurrence during the follow-up, with a mean recurrence time of 16.2 months (sd = 7.2) and a median recurrence time of 20 months (IQR = 12.5). Hospital stays, operation time, blood loss, and complication rates did not significantly differ between the two surgical methods. The local recurrence rate after en bloc resection was lower than piecemeal resection, although not statistically significant (P = 0.067).

CONCLUSIONS

The complication rates between the two surgical procedures were similar. Considering safety and local tumor control, en bloc resection is recommended as the primary choice for patients with chondrosarcoma/chordoma in the thoracic and lumbar regions who are eligible for this treatment.

Chondrosarcoma secondary to hereditary multiple osteochondromas with spinal cord compression: A case report and systematic review

Background

Hereditary multiple osteochondromas (HMOs) are a rare genetic disorder characterized by the formation of multiple benign osteochondromas that can undergo malignant transformation into chondrosarcoma.

Case Description

A 24-year-old male with a history of HMO and osteochondroma surgery 4 years ago, presented with back pain and paresthesias. The magnetic resonance showed a right paravertebral infiltrating mass at the T12-L1 level causing spinal cord compression. Following en bloc resection of the tumor, the patient's symptoms/ signs resolved. The final pathological diagnosis was consistent with a chondrosarcoma.

Conclusion

Chondrosarcomas secondary to HMO with spinal cord compression are rare. These patients often presenting with significant myelopathy/cord compression should undergo gross total resection where feasible to achieve the best outcomes.

The novel dynamic nomogram and risk classification system constructed for predicting post-surgical overall survival and mortality risk in primary chondrosarcoma: a population study based on SEER database

BACKGROUND

Surgery is the predominant method to improve the prognosis of primary chondrosarcoma patients. We aimed to construct the first reliable nomogram to predict the post-surgical overall survival (OS) of primary chondrosarcoma patients.

METHODS

We downloaded all primary chondrosarcoma patients treated with surgery between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database, and randomized them into training set (60%) and validation set (40%). Cox proportional regression analysis was applied to the training set to identify independent prognostic variables, and then constructed a nomogram for predicting 3-, 5-, and 8-year OS. The Harrell's concordance index (C-index), receiver operating characteristic curve (ROC), the area under curve (AUC), calibration curve and decision curve analysis (DCA) was used to assess the predictive efficacy and clinical applicability of the nomogram. The nomogram was also compared with The American Joint Committee on Cancer (AJCC) staging system.

RESULTS

A total of 1005 post-surgical primary chondrosarcoma patients were included in this study. We finally identified five independent prognostic variables to construct the nomogram, being age, grade, tumor size, disease stage and histological type. The C-index results showed that the prediction performance of the nomogram was significantly better than the AJCC staging system. In the training set, (C-index: 0.805, 95% CI 0.879-0.730 vs 0.686, 95% CI 0.606-0.766); in the validation set, (C-index: 0.811, 95% CI 0.895-0.727 vs 0.697, 95% CI 0.647-0.799). Additionally, the AUC values generated by the ROC were all greater than 0.8, which also indicated the excellent predictive performance of the nomogram. The calibration curves showed that the predicted survival rate was highly similar to the actual. Time-dependent ROC and DCA showed that the nomogram has better predictive performance and net clinical benefits than the AJCC staging system. Finally, a risk stratification system based on nomogram was constructed.

CONCLUSION

We successfully constructed and validated the first nomogram that could reliably predict 3-, 5-, and 8-year post-surgical OS in primary chondrosarcoma patients. Furthermore, the web-based dynamic nomogram could be more conveniently applied to clinic, providing assistance to surgeons and patients.

Patient, Disease, and Treatment-Related Factors Affecting Progression-Free and Disease-Specific Survival in Recurrent Chondrosarcomas of the Skull Base

BACKGROUND

Recurrent skull base chondrosarcomas (CSA) are difficult to treat, and limited data are available to help guide subsequent therapy.

OBJECTIVE

To further characterize the natural history of CSA and identify treatment modalities that were most effective in prolonging progression-free (PFS) and disease-specific survival (DSS).

METHODS

We conducted a single-institution retrospective review of patients with recurrent skull base CSA from 1993 to 2021. Kaplan-Meier survival analyses for PFS and DSS were completed. Univariable and multivariable Cox proportional hazards regression models were used to identify patient-related, treatment-related, and disease-related factors that predicted PFS and DSS.

RESULTS

A total of 28 patients and 84 episodes of recurrence were included. One-year PFS was 70.6%, 5-year PFS was 28.9%, and 10-year DSS was 78.5%. The median time to first progression was 23.9 months (range, 2.8-282 months). In univariable Cox proportional hazards regression, male sex, higher grade histology, fourth or greater progression episode status, distal pattern of recurrence, and treatment of recurrence without surgery or with chemotherapy alone predicted worse PFS. Multivariable regression predicted shortened DSS in male patients (hazard ratio [HR] 0.16; P = .021) and higher-grade tumors (HR 0.22; P = .039). Treatment of recurrence with surgery was associated with, but did not significantly predict, improved DSS (HR 1.78; P = .11).

CONCLUSION

Several patient and disease-specific factors were associated with shorter PFS and DSS in recurrent skull base chondrosarcoma. For recurrences amenable to resection, surgery is recommended for treatment of recurrent CSA. Local recurrence management without surgery results in shorter PFS and DSS.

Surgical Approaches to Tumors of the Occipito-Cervical, Subaxial Cervical, and Cervicothoracic Spine: An Algorithm for Standard versus Extended Anterior Cervical Access

OBJECTIVE

To propose a surgical approach algorithm for the tumors of the cervicothoracic spine.

METHODS

All patients operated for vertebral column tumors involving the occipito-cervicothoracic spine were reviewed. Oncologic characteristics and surgical approach were gathered. Approach was classified by the use of staging and trajectory (posterior, transnasal, transoral, transmandibular, transcervical, transsternal). Angle of attack was defined for the occipitocervical junction tumor as the angle inscribed by the inferior mandibular plane and line connecting the superior tumor pole and mandibular angle. For lesions extending below the thoracic inlet, angle of attack was that inscribed by the plane of the thoracic inlet and the line connecting the jugular notch and inferior tumor pole.

RESULTS

In total, 115 patients were included (mean age 56.7 years, 64 [56%] male, average size 26.5 cm³, 39 [34%] primary tumors). Sixty-nine (60%) of patients had single-stage procedures (57 [49.6%] posterior-only, 12 [10.4%] anterior-only), 35 (30.4%) had 2-stage procedures, and 11 (9.6%) had 3- or 4-stage approaches. Lesions requiring a combined transmandibular-transcervical approach all involved the C2 and C3 levels and had a significantly steeper angle of attack (42.5 ± 9.5 vs. 6.1 ± 13.3°; P = 0.01) and greater superior tumor extent above the inferior plane of the mandible (3.69 ± 2.18 vs. 0.33 ± 0.78; P = 0.002). Lateral tumor extent, tumor size, nor inferior angle of attack differed significantly between approach groups.

CONCLUSIONS

Here, we present a preliminary decision-making algorithm for the management of vertebral column tumors of the cervicothoracic spine. Based on this single-center experience, we suggest which patients, assessed via a combination of tumor histology and regional anatomy, may benefit from extended anterior surgical access.