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Study design <p>Systematic review.</p> Objective <p>To synthesise evidence on surgical management, reconstruction strategies, adjuvant therapies, survival outcomes, local recurrence, and prognostic factors in primary spinal osteosarcoma, with emphasis on margin status and multimodal therapy.</p> Methods <p>A PRISMA 2020-compliant systematic review was performed. PubMed/ MEDLINE, Scopus, Web of Science and Cochrane Library were searched through January 2026. Studies reporting outcomes in histologically confirmed primary spinal osteosarcoma were included. Institutional series and registry-based analyses were eligible. Extracted variables included surgical approach (en-bloc versus intralesional), reconstruction, chemotherapy, radiotherapy, survival, recurrence and prognostic factors. Owing to heterogeneity, qualitative synthesis was undertaken.</p> Results <p>Eighteen studies comprising 2,239 patients were included. Registry cohorts reported median overall survival of 15–23 months and 5-year survival below 20%. In contrast, selected Institutional surgical series demonstrated median survival exceeding 4–6 years in patients undergoing aggressive resection. En bloc or Enneking-appropriate resection was associated with improved local control and superior unadjusted survival; however, multivariable analyses did not consistently confirm an independent survival benefit. Local recurrence ranged from approximately 10% following en-bloc resection to more than 40% after intralesional resection. Multimodal chemotherapy remained standard. Modern radiotherapy techniques, including intensity-modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), proton-beam therapy and carbon-ion therapy, were increasingly utilised, especially in anatomically unresectable disease.</p> Conclusions <p>Primary spinal osteosarcoma carries poor population-level survival. Margin-negative resection improves local control, but outcomes are strongly influenced by tumour biology and stage. Multidisciplinary management at specialised centres is essential to optimise survival.</p>

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Is survival in primary spinal osteosarcoma determined by surgical margins or tumour biology? A systematic review

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月23日

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  • Vibhu Krishnan Viswanathan,
  • Sathish Muthu,
  • Dhibin Vikash Kolarpatti Ponnusamy,
  • Sathish Kumar Rajappan Chandra,
  • Khan Sharun,
  • Luke Hiatt,
  • Steven Theiss

摘要

Study design

Systematic review.

Objective

To synthesise evidence on surgical management, reconstruction strategies, adjuvant therapies, survival outcomes, local recurrence, and prognostic factors in primary spinal osteosarcoma, with emphasis on margin status and multimodal therapy.

Methods

A PRISMA 2020-compliant systematic review was performed. PubMed/ MEDLINE, Scopus, Web of Science and Cochrane Library were searched through January 2026. Studies reporting outcomes in histologically confirmed primary spinal osteosarcoma were included. Institutional series and registry-based analyses were eligible. Extracted variables included surgical approach (en-bloc versus intralesional), reconstruction, chemotherapy, radiotherapy, survival, recurrence and prognostic factors. Owing to heterogeneity, qualitative synthesis was undertaken.

Results

Eighteen studies comprising 2,239 patients were included. Registry cohorts reported median overall survival of 15–23 months and 5-year survival below 20%. In contrast, selected Institutional surgical series demonstrated median survival exceeding 4–6 years in patients undergoing aggressive resection. En bloc or Enneking-appropriate resection was associated with improved local control and superior unadjusted survival; however, multivariable analyses did not consistently confirm an independent survival benefit. Local recurrence ranged from approximately 10% following en-bloc resection to more than 40% after intralesional resection. Multimodal chemotherapy remained standard. Modern radiotherapy techniques, including intensity-modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), proton-beam therapy and carbon-ion therapy, were increasingly utilised, especially in anatomically unresectable disease.

Conclusions

Primary spinal osteosarcoma carries poor population-level survival. Margin-negative resection improves local control, but outcomes are strongly influenced by tumour biology and stage. Multidisciplinary management at specialised centres is essential to optimise survival.