Spine - 2026-04-01 - Journal Article
Statistics of Primary Malignant Spine Tumors in Japan: A Retrospective Study Using the Bone and Soft Tissue Tumor Registry in Japan.
Tsuchiya R, Ogura K, Ohtori S, Kawai A
Topics
Key Takeaway
Primary malignant spine tumors carry a 5-year disease-specific survival of 47.5%, with advanced TNM stage (IVA+IVB) conferring a 7.6-fold increased hazard of death compared to localized disease.
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Summary
This study analyzed 288 primary malignant spine tumor cases from the Japanese Orthopaedic Association BSTT Registry (2006–2019) to characterize epidemiology, treatment patterns, and survival. Surgery was performed in only 46.2% of cases, with intralesional margins achieved in 54.1% of those; 5-year DSS was 47.5%. On multivariate Cox analysis, chondrosarcoma (HR 0.23), chordoma (HR 0.27), and Ewing sarcoma (HR 0.42) had significantly better prognosis than osteosarcoma, while advanced TNM stage (IVA+IVB) was the strongest adverse factor (HR 7.60).
Key Limitation
Margin status (intralesional vs. wide) is not analyzed as an independent prognostic variable in the Cox model, which is the most surgically actionable factor and a critical omission given that 54.1% of operated cases had intralesional resections.
Original Abstract
STUDY DESIGN
A retrospective registry-based study.
OBJECTIVE
To elucidate the nationwide epidemiology, treatment patterns, and prognosis of primary malignant spine tumors (PMST) using the Japanese Orthopaedic Association's Bone and Soft Tissue Tumor (BSTT) Registry.
SUMMARY OF BACKGROUND DATA
PMSTs are rare, comprising a small proportion of primary malignant bone tumors. The surrounding anatomical structures make complete resection challenging, leading to poor prognoses. Studies using the Surveillance, Epidemiology, and End Results database have provided valuable epidemiological insights; however, limitations in the granularity and diversity of histologic subtypes persist, leaving detailed knowledge of PMSTs insufficiently clarified.
METHODS
We analyzed 288 PMST cases from the BSTT Registry (2006-2019), evaluating patient demographics, tumor characteristics, treatment details, and prognostic outcomes. Kaplan-Meier methods estimated disease-specific survival (DSS), and Cox proportional hazards models identified prognostic factors.
RESULTS
PMSTs accounted for 3.3% of primary malignant bone tumors. Common histologic subtypes included osteosarcoma (21.9%), chondrosarcoma (16.3%), chordoma (13.9%), and undifferentiated pleomorphic sarcoma (13.9%). Surgery was performed in 46.2% of cases, with intralesional margins in 54.1%. Chemotherapy and radiotherapy were administered in 42.0% and 54.9% of cases, respectively. The 5-year DSS was 47.5%. Adjusted analysis revealed favorable prognoses for chondrosarcoma [hazard ratio (HR): 0.23, 95% CI: 0.06-0.87, P =0.031], chordoma (HR: 0.27, 95% CI: 0.09-0.84, P =0.024), and Ewing sarcoma (HR: 0.42, 95% CI: 0.18-0.98, P =0.044) compared with osteosarcoma. Adults (40-64 yr) had better outcomes than the elderly (≥65 yr; HR: 0.43, 95% CI: 0.24-0.76, P =0.015). Advanced TNM stage (IVA + IVB) was an adverse prognostic factor (HR: 7.60, 95% CI: 1.85-31.18, P =0.005).
CONCLUSIONS
PMSTs are rare and present diverse histologic subtypes with poor prognoses. This study emphasizes the need for further investigations to optimize PMST management and improve prognoses.
LEVEL OF EVIDENCE
Level IIb.