Surgical Treatment of Malignant Pheochromocytomas in Spine

Surgical Treatment of Spinal Metastatic Pheochromocytoma and Paraganglioma: A Single Institutional Cohort of 18 Patients

STUDY DESIGN

Retrospective Cohort Study.

OBJECTIVES

To describe surgeries and treatment outcomes of metastatic pheochromocytomas and paragangliomas (PPGLs) on the spine.

METHODS

We reviewed a cohort of 18 patients with spinal PPGLs who were consecutively treated in our spinal center. Their clinical data was reviewed. The survival period and its relevant factors was then analyzed.

RESULTS

The cohort included ten cases of pheochromocytomas and eight paragangliomas. The local pain and neurological deficits were the two most common symptoms. One third of the spinal PPGLs were diagnosed as functional tumors, arousing secondary hypertension. The imaging features were consistent with those of osteolytic lesions. The surgical strategies for the cohort included percutaneous vertebroplasty, neurological decompression and partial tumor resection, and total en-bloc resection. The postoperative courses were uneventful except 1 patient developed heart failure. The adjuvant therapies were implemented in 6 patients with 131I-MIBG, five with radiotherapy, two with chemotherapy, and 1 with target therapy. The median survival period was 39 months, and the overall survival rate of 1 year was 77.8% (14/18). The patients' Karnofsky performance scores were positively correlated with the survival period (P < .05).

CONCLUSION

Surgery is indicated for intractable local pain and neurological impairment in the patients with spinal PPGLs. Palliative surgical strategies, including neurological decompression and partial tumor resection, could bring fair outcomes, especially for the patients in poor physical conditions.

Clinical features and prognosis analysis of metastatic spinal pheochromocytoma: A single center retrospective study

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It is difficult for clinicians to determine appropriate treatment strategies and predict the prognosis of metastatic spinal pheochromocytoma.

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Surgical treatment is an effective option in treating MSP and plays an important role in improving patients’ quality of life.

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Extraosseous metastasis, Tomita score, and number of spinal metastases are all potential prognostic factors for OS and PFS.

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Individualized treatment plans should be developed based on the actual situation of each patient.

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Through a multi-disciplinary collaboration and reasonable perioperative management, patients with MSP can be treated more effectively.

Purpose

Metastatic spinal pheochromocytoma (MSP) is very rare in clinical practice, with only a few case reports in the literature. Its low incidence makes it profoundly difficult for clinicians to determine appropriate treatment strategies and predict the prognosis. In this study, we analyzed the clinical characteristics, surgical procedure and prognosis of patients with MSP in one of the largest clinical investigations of this entity to date.

Methods

In this study, we conducted a retrospective analysis of the clinical data of 10 patients with MSP who were treated in our department from 2012 to 2020. We performed a total of 14 operations using two types of surgery: open surgery and percutaneous vertebroplasty.

Results

Among them, nine patients underwent 14 spinal operations with satisfactory effect and without any perioperative complications. The mean time from the initial operation to detection of spinal metastasis was 85.3 (12–132) months. The average follow-up time was 27.3 months. Disease progression was detected in nine patients, and eight patients (80%) died during the follow-up period. Univariate analysis showed that extraosseous visceral metastasis (P = 0.022), Tomita score (P = 0.027), and number of spinal metastases (P = 0.024) were associated with overall survival (OS). In addition, extraosseous visceral metastasis (P = 0.030), Tomita score (P = 0.013), and number of spinal metastases (P = 0.026) were associated with progression-free survival (PFS).

Conclusions

Surgical treatment is an effective option in treating MSP and plays an important role in improving patients’ quality of life, due to its efficacy in relieving pain, reconstruction of stability, and restoration of function. Extraosseous metastasis, Tomita score, and number of spinal metastases are all potential prognostic factors for OS and PFS.