Surgical Outcomes in Patients with Primary or Metastatic Spinal Leiomyosarcoma: A Systematic Review and Meta-Analysis

OBJECTIVE: To describe clinical features, treatments, and surgical outcomes of spinal leiomyosarcoma (sLMS). METHODS: We performed a systematic review and meta-analysis of 56 studies (January 1, 2000 to January 18, 2024) reporting on 109 patients: 39 (36%) with primary spinal lesions, 67 (61%) with metastases, and 3 (3%) with lesions of unknown origin. We compared clinical features, treatments, and outcomes between primary and metastatic sLMS. RESULTS: Lesions were thoracic in 56% of primary and 42% of metastatic cases (P = 0.07). En bloc resection was performed at a higher rate for metastases (22%) than for primary lesions (15%), and laminectomy/decompression was performed at a higher rate for metastases (25%) than for primary lesions (10%) (P = 0.07). Metastases received chemotherapy more frequently (49%) than primary lesions did (15%) (P = 0.002). Median overall survival was 46 months (95% confidence interval: 20-72 months) for metastases and was not reached for primary lesions. Median progression-free survival was 13 months (95% confidence interval: 10-19 months) for metastases and not reached for primary lesions. The following were associated with a greater likelihood of death: thoracic location (adjusted hazard ratio [aHR]: 27.6; P < 0.01), lumbar location (aHR: 26.9; P = 0.03), myelopathy (aHR: 26.4; P = 0.01), metastatic lesion (aHR: 11.8; P < 0.001), and male sex (aHR: 4.68; P = 0.01). CONCLUSIONS: We identified factors that may be associated with foreshortened survival after surgical resection for sLMS. Studies with longer follow-up are warranted to examine these relationships.