Survival After Surgery for Spinal Osteosarcoma and the Role of Chemotherapy and Treatment Sequencing: A National Cohort Multivariable Analysis
Taha Khalilullah, Shilp Shah, Vikas N. Vattipally, Karan Shah, Andrew M. Hersh, Joseph Dardick, Tej D. Azad, Yuanxuan Xia, Nicholas Theodore, Christian Meyer, Daniel LubelskiBACKGROUND AND OBJECTIVES:
Primary spinal osteosarcoma is a rare, morbid malignancy, frequently involving critical neurovascular structures and causing neurological compromise. Evidence guiding management is limited, and the benefit of surgery and perioperative chemotherapy is largely extrapolated from extremity disease. This study evaluates overall survival (OS) among surgically treated spinal osteosarcoma patients, examines the influence of chemotherapy and treatment sequence, and identifies predictors of chemotherapy administration.
METHODS:
Using the National Cancer Database (2004-2023), we identified patients with histologically confirmed spinal osteosarcoma who underwent surgery. Baseline characteristics were compared between surgery-only and surgery and chemotherapy cohorts. OS was assessed using Kaplan-Meier analysis, with interaction testing for grade and treatment effects. Multivariable Cox models were performed. A logistic regression model evaluated predictors of chemotherapy utilization.
RESULTS:
A total of 899 surgically treated patients were analyzed; 685 (76%) received chemotherapy. Before matching, the combination of surgery and chemotherapy was associated with superior 30-, 90-day, and 1-year survival (all
CONCLUSION:
Among patients undergoing resection for spinal osteosarcoma, perioperative chemotherapy was associated with improved early and unadjusted OS, with the greatest impact observed in high-grade tumors. However, this survival advantage was attenuated in adjusted analysis. These findings suggest that although chemotherapy remains critical in high-grade spinal osteosarcoma, its role in low-grade disease where toxicity may outweigh the benefit warrants further investigation.