High Grade Spinal Hemangioma: A National Cancer Database Analysis.

Background Spinal hemangiomas are common primary tumors of the vertebrae. Although these tumors are most frequently benign and asymptomatic, they can rarely exhibit aggressive growth and invasion into neighboring structures. Treatment for these aggressive variants are controversial, often involving surgery, chemotherapy, and/or radiotherapy. Objective This study seeks to investigate the current trends affecting overall survival using the National Cancer Database (NCDB) and to formulate treatment recommendations. Methods The NCDB was queried for spinal hemangiomas between 2004 and 2016. A Cox proportional-hazards model was used to perform multivariate regression analysis of survival. Survival curves for comparative visualization of demographic and treatment factors were generated using a semiparametric Cox approach. Results A cohort of 102 patients with histologically confirmed spinal hemangioma was identified in the database. Mean overall survival (OS) was 1.94 years. Administered treatments included surgical partial resection (n = 17), radical resection (n = 14), chemotherapy (n = 34), and radiotherapy (n = 56). Multivariate analysis revealed associations between decreased OS and advanced age (65+ years), and presence of metastasis. Cox survival analysis further revealed improved OS in patients who received surgical treatment and higher radiation dose. Conclusions The present retrospective analysis constitutes the largest cohort of patients with aggressive vertebral hemangiomas to date, finding that treatment with surgical resection and/or radiotherapy is associated with increased OS. Given that the mean OS of the study cohort was 1.94 years, our findings suggest that the optimal treatment regimen to maximize survival should consist of early surgical resection with adjuvant high-dose radiotherapy.