Outcomes After Surgical and Non-Surgical Management of Sarcoma Spine Metastasis: Meta-analysis and Literature Review

Purpose: There has been no systematic review specifically focused on spine metastasis from sarcoma. The aim of this study is to assess the clinical findings and outcomes of the treatment for spine metastasis from sarcomas from a literature review and systematic analysis. Methods: We queried PubMed for literature evaluating spine metastasis from sarcomas. Our review was constructed in accordance with preferred reporting items and meta-analyses (PRISMA) guidelines and protocol. The main outcome measure was survival time following medical and surgical management after diagnosis of metastatic sarcoma. Results: In total 451 papers were assessed. Eighteen articles in our search met inclusion and exclusion criteria. 64 patients were included in the analysis. Twenty-seven (42%) were female, and the mean age was 46. The most common location for metastasis was the thoracic spine with myxoid liposarcoma being the most common primary tumor (58%) followed by leiomyosarcoma (23%). In terms of treatment, 36 patients underwent non-surgical (chemotherapy or radiation) and surgical treatments, 13 underwent surgery only, nine underwent non-surgical treatment only, while six did not receive any treatment. The mean time from primary sarcoma diagnosis to spinal metastasis was 46.9 months. The mortality rate, based on the given follow up period of each study, was 67.7%, with a mean survival time of 48 months. We found no statistically significant difference among the groups (medical only HR 1.01, 95% CI 0.25-4.12; surgery only HR 1.19, 95% CI 0.35-3.99; medical and surgical HR 1.00 95% CI 0.34-2.92). Also, we found no statistically significant difference between patients treated with decompression and fusion versus en bloc resection (HR 1.24, 95% CI 0.58-2.64). Conclusion: Myxoid liposarcoma and leiomyosarcoma were the most common primary sarcomas that metastasize to spine and thoracic spine being the most location for them in our study. We found no significant difference in survival time after patient with spine sarcoma metastasis received medical management alone, surgical management alone, or combined medical and surgical management, and no significant difference and a trend towards decreased survival in patients who underwent wide en-bloc resection. Future studies with larger sample sizes should be conducted to explore additional outcome measures and delineate specific disease or patient specific factors that can guide our treatment algorithm for this challenging clinical presentation.