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Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROCProgram in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROCSchool of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung Taiwan
Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROCSchool of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung TaiwanDivision of Neurosurgery, Department of Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City 801, Taiwan
The revolution of most common pathological finding in intraspinal tumor was from nerve sheath tumors to metastasis.
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The most common origin of metastasis tumors were lung, lymphoma and Hepatocellular carcinoma.
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Oral and nasopharyngeal cancer was slight increasing number in our southern area than other area.
Abstract
Our institute presented two reports of intraspinal tumors, one in 1997 and the other in 2007, which assessed 120 and 117 cases of diagnosed and surgically treated intraspinal tumors at Kaohsiung Medical University Hospital, Southern Taiwan during 1988–1995 and 1999–2004, respectively. Here, we analyze data from 247 patients with medical records indicating surgery for and pathological reports of intraspinal tumors at the same institute during 2004–2014. Correlational findings from this study were compared with those from the previous two reports. There were 123 male and 124 female patients aged 7–93 (mean age: 55.4) years. The most common pathologic findings were metastasis (50.6%, 125/247), followed by nerve sheath tumors (30.8%, 76/247), meningiomas (6.0%, 15/247), and neuroepithelial tumors (5.2%, 13/247). A slight male predominance in metastasis and a slight female predominate in meningiomas were noted. The peak ages at diagnosis were 51–60 years. Motor weakness was the most common clinical presentation (46.1%). The thoracic spine segment was the most common location (51.4%, 127/247), followed by the lumbosacral (25.5%, 63/247) and cervical (23.1%, 57/247) spine segments. Among the metastatic tumors, the lung was the most common primary site of origin, followed by the liver (hepatocellular carcinoma), lymphoma, prostate, GI (gastrointestinal) tract, breast, and nasopharynx (nasopharyngeal cancer).
], which assessed 120 and 117 cases of diagnosed and surgically treated intraspinal tumors at Kaohsiung Medical University Hospital, Southern Taiwan during 1988–1995 and 1999–2004, respectively. The two reports analyzed epidemiological changes using pathological findings of nerve sheath tumors up to metastasis. In this study, we aimed to determine the clinicopathological difference in intraspinal tumors for 2004–2014 and analyze the 30-year evolution of the occurrence rate in Southern Taiwan.
2. Materials and methods
We compiled the medical records of 247 consecutive patients who underwent surgery for intraspinal tumors over 2004–2014 in Department of Neurosurgery, Kaohsiung Medical University Hospital. Data on the patient’s basic profile, topographical and anatomical location of tumors, pathological classification, and primary sites of origin of the metastatic tumor were included. The data were compared with those in our 1997 and 2007 reports and also with several series [
In total, 123 male and 124 female patients aged 7–93 (mean: 55.4) years. The frequencies of pathological classification of intraspinal tumors are listed in Table 1. The pathological findings revealed metastasis, nerve sheath tumors, meningiomas, neuroepithelial tumors, and other conditions in 50.6%, 30.8%, 6.0%, 5.2%, and 7.4% of patients, respectively. Compared with our two previous reports, the evolution of the pathological type changed from nerve sheath tumor to metastasis (Fig. 1). [
A slight male predominance was noted in metastatic tumors (male-to-female ratio = 72:53), whereas a slight female predominance was noted in meningiomas (male-to-female ratio = 3:12; Table 1).
Peak frequencies of intraspinal tumors occurred over the ages of 51–60 years. The average age of the patients at the time of surgery was 55.4 years, and 2.0% (5/247) of intraspinal tumors occurred when patients were aged <20 years (Table 2). Pathological results indicated neuroblastoma, primitive neuroectodermal tumor, astrocytoma, immature teratoma, and epidermoid cyst.
Table 2Incidence of 247 intraspinal tumors according to age and sex
The thoracic spine segment was the most common location (51.4%, 127/247), followed by the lumbosacral spine segment (25.5%, 63/247) and cervical spine segment (23.1%, 57/247). Nerve sheath tumor was the most frequent pathological finding in the cervical spine segment (50.8%, 29/57). Metastatic tumor was the most common finding in the thoracic spine segment (65.3%, 83/127) and lumbosacral spine segment (42.8%, 27/63). Meningiomas tended to be in the thoracic spine segment (50%, 7/14; Table 3).
Table 3Distribution of spinal tumors by segmental location and pathology classification
C
T
LS
Cases
Metastasis
15
83
27
125
NST
29
24
23
76
Meningioma
3
7
4
15
Neuroepitheial
8
3
2
13
Others
2
10
7
18
Total, n (%)
57 (23.1%)
127 (51.4%)
63 (25.5%)
247 (1 0 0)
C = cervical; T = thoracic; LS = lumbosacral. NST = Nerve sheath tumor
Weakness was the most common clinical presentation (46.1%, 114/247) in all intraspinal tumors, similar to metastatic tumors. Pain was the most common clinical presentation in nerve sheath tumors (50%, 38/76) and meningiomas (60%, 9/15; Table 4).
Table 4Clinical presentation and relationship with major pathologic classifications.
Our series had 125 cases of metastatic tumors. The most common location was the thoracic spine segment, and the most common primary sites of origin for metastatic tumors were the lung (32.0%, 40/125). This was followed by hepatic cell carcinoma (9.6%, 12/125), lymphoma (9.6%, 12/125), prostate cancer (8.8%, 11/125), gastrointestinal tract cancer (6.4%, 8/125), breast cancer (5.6%, 7/125), and nasopharyngeal cancer (5.6%, 7/125); 4.8% (6/125) of patients had unknown primary cancer (Table 5).
], such as the sex distribution and distribution of spinal tumors. However, several crucial changes have occurred in the last 30 years.
The first change is the pathological type of intraspinal tumors (Fig. 1), where metastatic tumors are the most common intraspinal lesions, replacing nerve sheath tumors [
]. This may be the result of improvements in both treatment for origin tumors and image modalities, especially sagittal T1-weighted MRI; these improvements prolong survival time and enable early diagnosis [
], where the age distribution with spinal tumors has changed, and the average age at diagnosis and surgery has increased over time (44.4 vs. 51.9 vs. 55.4 years). This is attributable to improvements in treatment, diagnostic tools, treatment attitudes among older patients, and management of an aging population in the past decade.
Third, the most common origin site of metastatic intraspinal tumors remained the lung, a finding identical to that in our previous two reports. However, over the past decade, HCC (hepatic cell carcinoma), lymphoma, and the prostate have become more common origins than the breast has been. These findings indicate advances in chemotherapy for breast cancer and for diseases associated with an aging population. Moreover, because of the hobby of chewing betel nut, particularly popular in Southern Taiwan’, oral and nasopharyngeal cancer rates have been slightly increasing in this region relative to other regions of Taiwan. Relative to the frequencies noted in our 1997 and 2007 report, glioblastoma multiforme in the spinal area has become more common in the past decade. This is attributable to improvements in the diagnosis and treatment of central nervous system–related tumors. Furthermore, metastatic tumors of unknown origin have become less common over time (32.1% vs. 15.1% vs. 4.8%). This decrease is attributable to improvements in pathological diagnosis. Finally, motor weakness is the most common clinical presentation, particularly in metastatic tumors. This finding is similar to those in our previous two reports. However, pain is more common in nerve sheath tumors and meningiomas relative to other conditions, a fact that may offer a clinical clue for diagnosis.
5. Conclusion
This study summarized 30-year surgical experience for intraspinal tumors in Southern Taiwan. The evolution of pathological findings from nerve sheath tumor to metastasis was the largest change. The most common origin site remained the lung, but lymphoma and HCC have become more common origins relative to conditions in the breast. This finding could offer clinical guidance.
Acknowledgment
This study received assistance from the patient registry system of the Neurosurgery Department in Kaohsiung Medical University Hospital
Appendix A. Supplementary data
The following are the Supplementary data to this article:
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