Risk Factors for Local Recurrence after Surgical Resection of Spine Schwannomas: Retrospective Analysis of 169 Patients from a Multicenter International Database
Notice bibliographique
Résumé
Introduction Schwannomas are benign neurogenic tumors, with a reported annual incidence between 0.3 and 0.5 per 100,000 people, mainly in their 4th and 5th decades, with no gender preference. Together with neurofibromas, they account for up to 30% of all intraspinal tumors. They usually present as a solitary slow-growing oval, lobulated and encapsulated mass, arising eccentrically from the nerve root sheath. Symptoms and signs are related to root and/or cord compression and may slowly progress with tumor growth. Total resection is the gold standard for patients with initial sensory or motor deficits. Local recurrence is reported to be around 5% and it usually occurs several years after the surgery. The objective of this study was to analyze a multicenter database of patients operated for spine schwannomas to identify risk factors for local recurrence. Patients and Methods Retrospective analysis of 169 patients (age > 18 years) from the AOSpine Multicenter Primary Spinal Tumors Database, who underwent surgery for a spine schwannoma (48% female, mean age at diagnosis 46.6 ± 15.31 years, mean follow-up 50.68 ± 39.23 months). Rates of tumor recurrence and time to recurrence were quantified. The predictive value of various clinical factors, including age, gender, tumor size, affected spinal segments, type of surgery, and extent of disease as defined by the Weinstein-Boriani-Biagini (WBB) classification system, was assessed. Descriptive statistics and univariate analysis was performed. Results The mean number of affected levels per patient was 1.85 ± 0.86 and 82.84% of them were located in the mobile spine (41.42% between L1 and L5). According to the WBB classification, 47.12% of the tumors had an intradural extension, while 31.73% were both intra- and extradural and the mean number of affected sectors was 4.49 ± 3.61. Regarding the surgery, 69.75% of the patients had an en bloc resection, mainly via a posterior approach (74.84%). Nine patients experienced local recurrence (5.3%) at a time range of 81 to 1,518 days after the surgery. These patients were on average younger (39.33 ± 15.58 vs. 47.01 ± 15.29), although this relationship did not reach significance (HR = 0.97, p = 0.16). Overall, 13, 10, and 7% of patients with cervical, sacral, and lumbar disease respectively, experienced tumor recurrence compared with 0% of thoracic patients ( p = 0.18). The location of the tumor ( p = 0.25), whether epidural, intradural or both, and the number of WBB sectors involved (HR = 1.03, p = 0.79) were not significantly related to recurrence. The actual size of the tumor was significantly larger in patients with recurrence (6.97 ± 4.66 vs. 3.81 ± 3.34) (HR = 1.16, p = 0.028), with the extent in the cranial-caudal direction posing the greatest hazard (HR = 1.324, p = 0.0018). With respect to surgical technique, patients receiving a complete resection (3.6%) had a significantly lower risk of recurrence than those treated with an intralesional subtotal procedure (13.9%, p = 0.047). Conclusion Local recurrence after schwannoma resection appears to be determined mainly by the size of the tumor and the extent of the surgical resection.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».