The effects of postoperative neurological deficits on overall survival in patients with malignant peripheral nerve sheath tumors.
OBJECTIVE Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive sarcomas with peripheral nerve differentiation. Surgical management of MPNSTs entails wide resection with negative margins, although the extent of resection required to achieve oncological control may result in postoperative neurological morbidity. The association between postoperative neurological deficits and survival outcomes in patients with MPNSTs remains poorly defined. In this study, the authors evaluated the association between new or worsening postoperative neurological deficits and overall survival (OS) following resection for MPNSTs. METHODS A retrospective review of all patients who underwent resection for MPNSTs at Johns Hopkins Hospital between 2010 and 2024 was performed. Postoperative neurological deficits were defined as new or worsened motor or sensory impairment documented on postoperative examination compared with preoperative baseline. Deficits were classified as transient if they resolved within 3 months or permanent if they persisted beyond 3 months. OS was assessed using Kaplan-Meier analysis. Uni- and multivariable Cox proportional hazards models were used to evaluate the association between postoperative neurological deficits and OS, adjusting for tumor characteristics and extent of resection. RESULTS A total of 116 patients underwent resection during the study period, 49 (42.2%) of whom developed a postoperative neurological deficit. The median overall follow-up duration was 20.6 (interquartile range 8.6-56.2) months. Permanent neurological deficits were more common among patients with spinal tumors (35.3% vs 11.9%, p = 0.046). The presence of a permanent deficit was associated with worse OS (hazard ratio [HR] 3.64, 95% CI 1.97-6.72) compared with transient or no deficits. When stratified by extent of resection, patients who underwent gross-total resection (GTR) without a neurological deficit demonstrated the longest OS, followed by GTR with a deficit, subtotal resection (STR) without a deficit, and STR with a deficit. On multivariable analysis, the development of a permanent postoperative neurological deficit remained independently associated with worse OS (HR 8.50, 95% CI 2.77-14.59). CONCLUSIONS In patients undergoing resection for MPNSTs, the development of a permanent postoperative neurological deficit was independently associated with decreased OS. These findings underscore the importance of balancing maximal oncological resection with preservation of neurological function to optimize long-term outcomes in patients with MPNSTs.