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.
Melanie Alfonzo Horowitz, J. Khalifeh, Xinlan Yang et al.· Journal of Neurosurgery : Sp...· 0 citations
OBJECTIVE
Renal cell carcinoma (RCC) is a common malignancy that metastasizes to the spine, leading to complex treatment challenges and reduced survival. The aim of this study was to evaluate the prevalence of oncological biomarkers in patients with RCC spinal metastasis and analyze how these biomarkers, along with clinical factors, impact survival outcomes.
METHODS
This retrospective cohort study included patients with RCC spinal metastasis who were treated surgically at a single academic center between 2013 and 2024. Clinical, surgical, and treatment data were collected. Immunohistochemical analysis of the 10 most prevalent biomarkers was performed on spinal tumor specimens. Predictive modeling of overall mortality was conducted using multivariate logistic regression, decision tree, and random forest algorithms. Model performance was assessed using the area under the curve, and key interactions were identified through interaction depth analysis. Unsupervised clustering was used to stratify patients into biomarker-defined risk groups.
RESULTS
Thirty-six patients (mean age 60 years) were included in the analysis. The overall mortality rate was 61.1%, with a mean follow-up duration after diagnosis of spinal metastasis of 16.1 months. CK7 and AE1/AE3 were the most significant predictors of mortality, with CK7-positive and AE1/AE3-negative patients having an 80% mortality rate versus 25% in AE1/AE3-positive patients (p < 0.01). CAM5.2 and KRAS expression were associated with 100% and 80% mortality, respectively. Patients with EGFR positivity and CK7 negativity had 0% mortality (p = 0.01). Decision tree analysis identified CAM5.2, CK7, and AE1/AE3 as key hierarchical classifiers. In the random forest analysis, CK7 and AE1/AE3 (mean minimal depths of 2.04 and 2.34, respectively) had the highest variable importance scores (Gini p < 0.01) (area under the curve: logistic regression = 0.74; decision tree = 0.72; random forest = 0.81). Unsupervised clustering stratified patients into three molecular subgroups with distinct mortality risks: cluster 1 (61.5%), cluster 2 (50.0%), and cluster 3 (66.7%).
CONCLUSIONS
Immunohistochemical biomarkers, particularly CK7, AE1/AE3, CAM5.2, and EGFR, hold significant prognostic value in RCC spinal metastasis and can help stratify patients into high- and low-risk groups. The integration of these biomarkers into tree-based machine learning models provides interpretable data-driven decision tools to support personalized surgical and systemic treatment planning. These findings warrant validation in larger multi-institutional prospective cohorts and further analysis of biomarker interactions.
Joseph Rajasekaran, Xinlan Yang, A. Ghaith et al.· Journal of Neurosurgery : Sp...· 0 citations
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