Surgical management and outcome of synovial sarcoma in the spine

Abstract Background Synovial sarcoma (SS) is a soft tissue sarcoma that rarely occurs in the spine, and a minimal number of cases have been reported in the literature. Spinal SS is challenging in diagnosis and treatment and has a poor prognosis. The aim of this study was to summarize and analyse the clinical features and outcomes of patients with spinal SS. Methods A total of 16 cases of patients with spinal SS admitted to our institution were reviewed retrospectively. General information, radiological findings and treatment strategies were collected. These patients were followed up regarding their continuing treatment, local or distant recurrence and survival. Results Spinal SS patients in this series ranged in age from 12 to 68 years (median, 33). Four en bloc resections and 12 piecemeal resections were performed. Improved Frankel (P = 0.002), visual analogue scale (P = 0.002) and Karnofsky Performance Status (P = 0.002) scores were seen postoperatively. The mean follow-up period was 35.9 ± 23.5 (median 31.5, range 4–87) months, with four local recurrences and three distant metastases detected. Eight patients (50.0%) died of disease by the last follow-up. The 1-, 3- and 5-year overall survival rates were 87.5%, 61.4% and 40.9%, respectively. Preoperative chemotherapy was used in three patients to facilitate surgical resection, and adjuvant chemotherapy and radiotherapy were used in six patients. Conclusions Spinal SS has a relatively high risk of local recurrence and distant metastasis. Surgical intervention can improve the neurological function and relieve pain in these patients. En bloc excision is an effective treatment strategy to improve survival and prevent local recurrence. Management of spinal SS should be under the instruction of a multidisciplinary team

Outcomes and prognostic factors for surgically treated patients with breast cancer spine metastases

Purpose: The aim of this study is to provide some useful insights into the treatments, outcomes, and prognostic factors of patients with breast cancer spine metastases (BCSM). Methods: We report a retrospective case series analyzing 87 patients with BCSM who underwent surgical interventions. Independent prognostic factors for SMFS and OS were extracted using univariate and multivariate analyses, the Kaplan–Meier method and the Cox proportional hazards model. Results: The mean time between primary diagnoses and spinal metastases was 46.8 (median 41, range 0–147 months) months. The analysis showed that lymph node metastasis (p = 0.043, HR 10.498, 95%CI 1.074–102.588) and estrogen receptor (ER) status (p = 0.004, HR 0.368, 95%CI 0.189–0.721) can significantly affect SMFS. Furthermore, visceral metastasis (p = 0.042, HR 2.383, 95%CI 1.032–5.501), multiple metastases (p = 0.035, HR 2.538, 95%CI 1.066–6.048) and post-op chemotherapy (p = 0.003, HR 0.312, 95%CI 0.144–0.675) have significant effects on OS. Lastly, patients identified as Luminal A subtype have longer OS. Conclusions: Lymph node metastases and ER status are independent risk factors in predicting BCSM. Moreover, visceral metastasis, multiple metastases of the spine and post-op chemotherapy are independent prognostic factors. Luminal subtypes have higher rate, but late onset of spine metastases and prolonged survival. Keywords: Breast cancer spine metastasis, Prognostic factors, Survival, Kaplan–Meier method, Perou's classificatio