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Purpose <p>Lumbosacral spinal solitary fibrous tumors (SFTs) are rare, and their clinicopathological profile, surgical management, and recurrence behavior have not been systematically characterized as a dedicated anatomical subgroup. We assembled a lumbosacral-specific cohort to describe these tumors and identify factors associated with recurrence, with particular attention to dural compartment, extent of resection, and compartment-specific surgical constraints.</p> Methods <p>We systematically reviewed reported lumbosacral spinal SFTs–both STAT6-confirmed and historically classified–together with the present case, extracting clinical, imaging, surgical, histopathological, and follow-up data. Associations with recurrence were assessed for tumor size (Mann–Whitney U test), resection extent, and dural compartment (Fisher’s exact test, Kaplan–Meier estimation, log-rank), with Cox regression for recurrence-free survival.</p> Results <p>Sixty patients were included (17 STAT6-positive, 43 historically classified). Tumors were predominantly extradural (20 of 33 with a documented compartment). Locoregional recurrence or distant metastasis occurred in 21.7% (crude); the Kaplan–Meier estimated cumulative probability of an RFS event was approximately 26% at 3 years and 37% at 5 years. Recurrent tumors were larger than non-recurrent tumors (median 6.7 vs. 3.0&#xa0;cm; <i>p</i> = 0.021). Local recurrence was substantially less frequent after complete than after subtotal resection (16.1% vs. 55.6%; <i>p</i> = 0.029).</p> Conclusion <p>In this pooled cohort, larger tumor size was associated with recurrence, and local recurrence was less frequent after complete than after subtotal resection. The dural compartment appears to influence the surgical technique and margin that can realistically be achieved rather than whether complete removal is possible: extradural tumors more often permit en bloc, margin-negative excision, whereas intradural lesions involving the cauda equina, though frequently removable in full, generally require piecemeal function-preserving removal. Given the potential for delayed recurrence, long-term postoperative surveillance is warranted.</p>

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Lumbosacral spinal solitary fibrous tumors: compartment-specific surgical considerations and recurrence patterns in 60 systematically reviewed cases

  • 期刊论文

  • 发表日期：

    2026年7月29日

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  • Salim Khayat,
  • Herbert Daniel Jiménez-Zapata,
  • Carlos A. Rodríguez-Arias

摘要

Purpose

Lumbosacral spinal solitary fibrous tumors (SFTs) are rare, and their clinicopathological profile, surgical management, and recurrence behavior have not been systematically characterized as a dedicated anatomical subgroup. We assembled a lumbosacral-specific cohort to describe these tumors and identify factors associated with recurrence, with particular attention to dural compartment, extent of resection, and compartment-specific surgical constraints.

Methods

We systematically reviewed reported lumbosacral spinal SFTs–both STAT6-confirmed and historically classified–together with the present case, extracting clinical, imaging, surgical, histopathological, and follow-up data. Associations with recurrence were assessed for tumor size (Mann–Whitney U test), resection extent, and dural compartment (Fisher’s exact test, Kaplan–Meier estimation, log-rank), with Cox regression for recurrence-free survival.

Results

Sixty patients were included (17 STAT6-positive, 43 historically classified). Tumors were predominantly extradural (20 of 33 with a documented compartment). Locoregional recurrence or distant metastasis occurred in 21.7% (crude); the Kaplan–Meier estimated cumulative probability of an RFS event was approximately 26% at 3 years and 37% at 5 years. Recurrent tumors were larger than non-recurrent tumors (median 6.7 vs. 3.0 cm; p = 0.021). Local recurrence was substantially less frequent after complete than after subtotal resection (16.1% vs. 55.6%; p = 0.029).

Conclusion

In this pooled cohort, larger tumor size was associated with recurrence, and local recurrence was less frequent after complete than after subtotal resection. The dural compartment appears to influence the surgical technique and margin that can realistically be achieved rather than whether complete removal is possible: extradural tumors more often permit en bloc, margin-negative excision, whereas intradural lesions involving the cauda equina, though frequently removable in full, generally require piecemeal function-preserving removal. Given the potential for delayed recurrence, long-term postoperative surveillance is warranted.