Incidence, Management, and Outcomes of Spinal Giant Cell Tumor of Bone in Adult Patients: A National Cancer Database Analysis.

OBJECTIVE: Giant cell tumors (GCTs) make up 5% of all primary bone tumors with spinal GCTs making up 2-15% of all GCTs. The standard of care for spinal GCT is maximal surgical resection, but many adjuvant therapies have been employed due to the difficulty of achieving gross total resection combined with a high local recurrence rate. The purpose of this study was to analyze the incidence, management, and outcomes of spinal GCT.

METHODS: Patients with diagnosis codes specific for spinal GCT were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization.

RESULTS: The search criteria identified 92 patients in the NCDB dataset from 2004-2016 who had been diagnosed with spinal GCT. 64.1% of patients received surgical intervention, 24.8% received radiation therapy, and 15.2% of patients received immunotherapy. Univariately, age ≥ 55 and tumor location in sacrum/coccyx were associated with worsened OS while surgical resection was associated with improved OS. On multivariate analysis, age 55-64 was associated with worsened OS and radical surgical resection was associated with improved OS. Survival analysis revealed improved OS with surgery but not radiation, chemotherapy, or immunotherapy.

CONCLUSION: Spinal GCT is a rare primary bone tumor of the vertebral column. Standard of care management is surgical resection with a goal of gross total resection; however, adjuvant therapies are often used. Our study found that surgical resection significantly improved OS while immunotherapy nears significance in improving OS.