{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:10:42Z","timestamp":1779527442282,"version":"3.53.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,8]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The goal of this study was to investigate the local recurrence rate and long-term survival after resection of spinal sarcomas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review of patients who underwent resection of primary or metastatic spinal sarcomas between 1997 and 2015 was performed. Tumors were classified according to the Enneking classification, and resection was categorized as Enneking appropriate (EA) if the specimen margins matched the Enneking recommendation, and as Enneking inappropriate (EI) if they did not match the recommendation. The primary outcome measure for all tumors was overall survival; local recurrence was also an outcome measure for primary sarcomas. The association between clinical, surgical, and molecular (tumor biomarker) factors and outcomes was also investigated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 60 patients with spinal sarcoma were included in this study (28 men and 32 women; median age 38 years). There were 52 primary (86.7%) and 8 metastatic sarcomas (13.3%). Thirty-nine tumors (65.0%) were classified as high-grade, and resection was considered EA in 61.7% of all cases (n = 37). The local recurrence rate was 10 of 52 (19.2%) for primary sarcomas; 36.8% for EI resection and 9.1% for EA resection (p = 0.010). Twenty-eight patients (46.7%) died during the follow-up period, and median survival was 26 months. Overall median survival was longer for patients with EA resection (undefined) compared with EI resection (13 months, p &lt; 0.001). After multivariate analysis, EA resection significantly decreased the hazard of local recurrence (HR 0.24, 95% CI 0.06\u20130.93; p = 0.039). Age 40 years or older (HR 4.23, 95% CI 1.73\u201310.31; p = 0.002), previous radiation (HR 3.44, 95% CI 1.37\u20138.63; p = 0.008), and high-grade sarcomas (HR 3.17, 95% CI 1.09\u20139.23; p = 0.034) were associated with a significantly increased hazard of death, whereas EA resection was associated with a significantly decreased hazard of death (HR 0.22, 95% CI 0.09\u20130.52; p = 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The findings in the present study suggest that EA resection may be the strongest independent prognostic factor for improved survival in patients with spinal sarcoma. Additionally, patients who underwent EA resection had lower local recurrence rates. Patients 40 years or older, those with a history of previous radiation, and those with high-grade tumors had an increased hazard of mortality in this study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2016.5.focus16118","type":"journal-article","created":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T03:37:36Z","timestamp":1470022656000},"page":"E9","source":"Crossref","is-referenced-by-count":12,"title":["Clinical, surgical, and molecular prognostic factors for survival after spinal sarcoma resection"],"prefix":"10.3171","volume":"41","author":[{"given":"Daniel M.","family":"Sciubba","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"De la Garza Ramos","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Rory Goodwin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Abu-Bonsrah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy F.","family":"Witham","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetan","family":"Bettegowda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziya L.","family":"Gokaslan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul","family":"Wolinsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16118","series-title":"Eur Rev Med Pharmacol Sci","first-page":"831","article-title":"Ewing's sarcoma of the mobile spine","volume":"15","author":"Boriani","year":"2011"},{"key":"b2-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"493","article-title":"Chordoma of the mobile spine: fifty years of experience","volume":"31","author":"Boriani","year":"2006"},{"key":"b3-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"1927","article-title":"En bloc resections of bone tumors of the thoracolumbar spine. A preliminary report on 29 patients","volume":"21","author":"Boriani","year":"1996"},{"key":"b4-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"804","article-title":"Chondrosarcoma of the mobile spine: report on 22 cases","volume":"25","author":"Boriani","year":"2000"},{"key":"b5-focus16118","series-title":"Clin Sarcoma Res","first-page":"14","article-title":"The epidemiology of sarcoma.","volume":"2","author":"Burningham","year":"2012"},{"key":"b6-focus16118","series-title":"Med Oncol","first-page":"886","article-title":"Expression of PTEN and mTOR in sacral chordoma and association with poor prognosis.","volume":"31","author":"Chen","year":"2014"},{"key":"b7-focus16118","series-title":"Clin Med Res","first-page":"147","article-title":"The promise of molecular profiling for cancer identification and treatment","volume":"2","author":"Cross","year":"2004"},{"key":"b8-focus16118","series-title":"PLoS One","first-page":"e20294","article-title":"Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing.","volume":"6","author":"Ducimeti\u00e8re","year":"2011"},{"issue":"153","key":"b9-focus16118","series-title":"Clin Orthop Relat Res","first-page":"106","article-title":"A system for the surgical staging of musculoskeletal sarcoma.","author":"Enneking","year":"1980"},{"issue":"415","key":"b10-focus16118","series-title":"Clin Orthop Relat Res","first-page":"4","article-title":"A system for the surgical staging of musculoskeletal sarcoma. 1980","author":"Enneking","year":"2003"},{"key":"b11-focus16118","series-title":"Clin Transl Oncol","first-page":"191","article-title":"Clinical and molecular prognostic predictors of malignant peripheral nerve sheath tumor","volume":"16","author":"Fan","year":"2014"},{"key":"b12-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"830","article-title":"Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence","volume":"36","author":"Fisher","year":"2011"},{"key":"b13-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"678","article-title":"Surgical management of spinal chondrosarcomas","volume":"41","author":"Fisher","year":"2016"},{"key":"b14-focus16118","series-title":"Spine J","first-page":"110","article-title":"Epidemiologic, functional, and oncologic outcome analysis of spinal sarcomas treated surgically at a single institution over 10 years","volume":"15","author":"Groves","year":"2015"},{"key":"b15-focus16118","series-title":"J Am Acad Orthop Surg","first-page":"646","article-title":"Malignant osseous tumors of the pediatric spine","volume":"20","author":"Kim","year":"2012"},{"key":"b16-focus16118","series-title":"Stem Cells","first-page":"833","article-title":"Radiation-induced reprogramming of breast cancer cells","volume":"30","author":"Lagadec","year":"2012"},{"key":"b17-focus16118","series-title":"Curr Treat Options Oncol","first-page":"482","article-title":"Surgical treatment of sarcomas of the spine","volume":"15","author":"Ozturk","year":"2014"},{"key":"b18-focus16118","series-title":"J Neurosurg Spine","first-page":"120","article-title":"Surgical management of primary and metastatic sarcoma of the mobile spine","volume":"9","author":"Rao","year":"2008"},{"issue":"22 Suppl","key":"b19-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"S58","article-title":"Ewing and osteogenic sarcoma: evidence for multidisciplinary management","volume":"34","author":"Sciubba","year":"2009"},{"key":"b20-focus16118","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"355","article-title":"Influence of previous radiation exposure on pathologic features and clinical outcome in patients with thyroid cancer","volume":"135","author":"Seaberg","year":"2009"},{"key":"b21-focus16118","series-title":"Cancer Epidemiol Biomarkers Prev","first-page":"1985","article-title":"Epidemiologic and molecular prognostic review of glioblastoma","volume":"23","author":"Thakkar","year":"2014"},{"key":"b22-focus16118","series-title":"Int Orthop","first-page":"291","article-title":"Total en bloc spondylectomy for solitary spinal metastases","volume":"18","author":"Tomita","year":"1994"},{"key":"b23-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"298","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita","year":"2001"},{"key":"b24-focus16118","series-title":"J Neurooncol","first-page":"349","article-title":"Malignant peripheral nerve sheath tumor (MPNST) in the spine: a retrospective analysis of clinical and molecular prognostic factors","volume":"122","author":"Wang","year":"2015"},{"key":"b1-focus16118","series-title":"Eur Rev Med Pharmacol 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A preliminary report on 29 patients","volume":"21","author":"Boriani","year":"1996"},{"key":"b4-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"804","article-title":"Chondrosarcoma of the mobile spine: report on 22 cases","volume":"25","author":"Boriani","year":"2000"},{"key":"b5-focus16118","series-title":"Clin Sarcoma Res","first-page":"14","article-title":"The epidemiology of sarcoma.","volume":"2","author":"Burningham","year":"2012"},{"key":"b6-focus16118","series-title":"Med Oncol","first-page":"886","article-title":"Expression of PTEN and mTOR in sacral chordoma and association with poor prognosis.","volume":"31","author":"Chen","year":"2014"},{"key":"b7-focus16118","series-title":"Clin Med Res","first-page":"147","article-title":"The promise of molecular profiling for cancer identification and treatment","volume":"2","author":"Cross","year":"2004"},{"key":"b8-focus16118","series-title":"PLoS One","first-page":"e20294","article-title":"Incidence of sarcoma histotypes and molecular subtypes in a prospective epidemiological study with central pathology review and molecular testing.","volume":"6","author":"Ducimeti\u00e8re","year":"2011"},{"issue":"153","key":"b9-focus16118","series-title":"Clin Orthop Relat Res","first-page":"106","article-title":"A system for the surgical staging of musculoskeletal sarcoma.","author":"Enneking","year":"1980"},{"issue":"415","key":"b10-focus16118","series-title":"Clin Orthop Relat Res","first-page":"4","article-title":"A system for the surgical staging of musculoskeletal sarcoma. 1980","author":"Enneking","year":"2003"},{"key":"b11-focus16118","series-title":"Clin Transl Oncol","first-page":"191","article-title":"Clinical and molecular prognostic predictors of malignant peripheral nerve sheath tumor","volume":"16","author":"Fan","year":"2014"},{"key":"b12-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"830","article-title":"Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence","volume":"36","author":"Fisher","year":"2011"},{"key":"b13-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"678","article-title":"Surgical management of spinal chondrosarcomas","volume":"41","author":"Fisher","year":"2016"},{"key":"b14-focus16118","series-title":"Spine J","first-page":"110","article-title":"Epidemiologic, functional, and oncologic outcome analysis of spinal sarcomas treated surgically at a single institution over 10 years","volume":"15","author":"Groves","year":"2015"},{"key":"b15-focus16118","series-title":"J Am Acad Orthop Surg","first-page":"646","article-title":"Malignant osseous tumors of the pediatric spine","volume":"20","author":"Kim","year":"2012"},{"key":"b16-focus16118","series-title":"Stem Cells","first-page":"833","article-title":"Radiation-induced reprogramming of breast cancer cells","volume":"30","author":"Lagadec","year":"2012"},{"key":"b17-focus16118","series-title":"Curr Treat Options Oncol","first-page":"482","article-title":"Surgical treatment of sarcomas of the spine","volume":"15","author":"Ozturk","year":"2014"},{"key":"b18-focus16118","series-title":"J Neurosurg Spine","first-page":"120","article-title":"Surgical management of primary and metastatic sarcoma of the mobile spine","volume":"9","author":"Rao","year":"2008"},{"issue":"22 Suppl","key":"b19-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"S58","article-title":"Ewing and osteogenic sarcoma: evidence for multidisciplinary management","volume":"34","author":"Sciubba","year":"2009"},{"key":"b20-focus16118","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"355","article-title":"Influence of previous radiation exposure on pathologic features and clinical outcome in patients with thyroid cancer","volume":"135","author":"Seaberg","year":"2009"},{"key":"b21-focus16118","series-title":"Cancer Epidemiol Biomarkers Prev","first-page":"1985","article-title":"Epidemiologic and molecular prognostic review of glioblastoma","volume":"23","author":"Thakkar","year":"2014"},{"key":"b22-focus16118","series-title":"Int Orthop","first-page":"291","article-title":"Total en bloc spondylectomy for solitary spinal metastases","volume":"18","author":"Tomita","year":"1994"},{"key":"b23-focus16118","series-title":"Spine (Phila Pa 1976)","first-page":"298","article-title":"Surgical strategy for spinal metastases","volume":"26","author":"Tomita","year":"2001"},{"key":"b24-focus16118","series-title":"J Neurooncol","first-page":"349","article-title":"Malignant peripheral nerve sheath tumor (MPNST) in the spine: a retrospective analysis of clinical and molecular prognostic factors","volume":"122","author":"Wang","year":"2015"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/2\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/2\/article-pE9.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/41\/2\/article-pE9.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:00:11Z","timestamp":1779526811000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/41\/2\/article-pE9.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,8]]},"references-count":48,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2016.5.focus16118","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,8]]}}}