Clinical characteristics, radiological findings, treatment patterns, and prognostic factors in spinal alveolar soft part sarcoma: a single-center retrospective cohort study

Abstract

Spinal alveolar soft part sarcoma (ASPS) is rare, and evidence regarding its optimal management remains limited. We aimed to describe the clinical and radiological features of spinal ASPS, assess treatment patterns, and identify factors associated with overall survival (OS). We reviewed 20 patients with spinal ASPS who underwent surgery at a single center between 2012 and 2023. Clinical, radiological, surgical, pathological, and treatment data were collected. OS was analyzed using the Kaplan–Meier method and compared using the log-rank test. Hazard ratios were estimated using univariate Cox regression, followed by multivariable Cox regression. The cohort included 17 males and 3 females (mean age, 33.95 years). Fourteen patients (70.0%) had metastatic disease, including 12 before surgery and 2 after surgery. All underwent posterior resection and reconstruction; 12 underwent en-bloc resection and 8 underwent subtotal resection. Mean intraoperative blood loss was 2400 mL, and 16 patients required transfusion. Early postoperative evaluation showed marked symptomatic or neurological improvement in 11 patients (55.0%), partial improvement in 4 (20.0%), stable or limited change in 4 (20.0%), and neurological deterioration in 1 (5.0%). During a mean follow-up of 33.15 months, 9 patients were alive and 11 had died; median OS was 28.0 months. Univariate radiological analysis showed that tumor boundary clarity ( P < 0.001), enhancement pattern ( P = 0.013), and T2-weighted signal intensity ( P = 0.032) were significantly associated with OS. In multivariable analysis, immunotherapy (HR = 0.092, P = 0.039) and better preoperative neurological status (Frankel grade D–E; HR = 0.079, P = 0.006) were independently associated with longer OS. En-bloc resection showed a favorable survival trend (HR = 0.236, P = 0.070), although the association did not reach statistical significance. Spinal ASPS is a highly vascular and surgically demanding malignancy with a substantial metastatic burden. Preoperative tissue diagnosis and selective embolization should be considered when appropriate. En-bloc resection showed a favorable trend toward longer OS, although this association did not reach statistical significance in this cohort. Immunotherapy and better preoperative neurological status were associated with longer OS. Not applicable.