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Objective This study aimed to correlate the expression, by immunohistochemistry, of the proteins OPN, ABCB5, and WNT3A from anatomopathological materials obtained from paraffin blocks, slides, or both, from patients with osteosarcoma (OS), analyzing epidemiological characteristics, as well as their presence and influence on the evolution and progression of the disease. Methods After the initial case selection, we searched for the respective paraffin blocks and took only those with sufficient tumor mass to allow additional sections with no complete loss of biological material. The sarcoma area identification in representative paraffin blocks used multisample blocks (tissue microarray [TMA]) created on a BenchMark ULTRA (Roche Diagnostics Corporation, Indianapolis, IN, USA) instrument. Then, we analyzed the association between the expression of ABCB5, WNT3A, and osteopontin (OPN) markers with the variables age, location, and tissue type (Fisher exact test/Chi-squared test). Results The average age of the patients was 23 years, and the rate of males and females was the same. We analyzed 40 slides from 28 OS patients seen from 2005 to 2017. Their follow-up time was 80.0 months, and the 5-year survival rate was 46.7%. Most metastases occurred in lung tissue (92.9%). Proteins ABCB5, OPN, and WNT3A did not present statistical significance when compared with age group, neo-adjuvant, adjuvant, or both, chemotherapy, location, survival, or death. Osteopontin was negative in all samples. WNT3A expression occurred in patients who died early. Conclusion In an immunohistochemical study, ABCB5, OPN, and WNT3A did not have statistical significance. In the parameters analyzed, they did not seem to be a predictive or aggressive factor for OS.

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Abstract Objective This study aimed to correlate the expression, by immunohistochemistry, of the proteins OPN, ABCB5, and WNT3A from anatomopathological materials obtained from paraffin blocks, slides, or both, from patients with osteosarcoma (OS), analyzing epidemiological characteristics, as well as their presence and influence on the evolution and progression of the disease. Methods After the initial case selection, we searched for the respective paraffin blocks and took only those with sufficient tumor mass to allow additional sections with no complete loss of biological material. The sarcoma area identification in representative paraffin blocks used multisample blocks (tissue microarray [TMA]) created on a BenchMark ULTRA (Roche Diagnostics Corporation, Indianapolis, IN, USA) instrument. Then, we analyzed the association between the expression of ABCB5, WNT3A, and osteopontin (OPN) markers with the variables age, location, and tissue type (Fisher exact test/Chi-squared test). Results The average age of the patients was 23 years, and the rate of males and females was the same. We analyzed 40 slides from 28 OS patients seen from 2005 to 2017. Their follow-up time was 80.0 months, and the 5-year survival rate was 46.7%. Most metastases occurred in lung tissue (92.9%). Proteins ABCB5, OPN, and WNT3A did not present statistical significance when compared with age group, neo-adjuvant, adjuvant, or both, chemotherapy, location, survival, or death. Osteopontin was negative in all samples. WNT3A expression occurred in patients who died early. Conclusion In an immunohistochemical study, ABCB5, OPN, and WNT3A did not have statistical significance. In the parameters analyzed, they did not seem to be a predictive or aggressive factor for OS.

Resumo Objetivo Correlacionar a expressão, por imunoistoquímica, das proteínas OPN, ABCB5 e WNT3A de material anatomopatológico, obtido de blocos de parafina e/ou lâminas, em pacientes com osteossarcoma (OS), analisando as características epidemiológicas, sua presença e influência na evolução e progressão da doença. Métodos Após a seleção inicial dos casos, ocorreu a busca dos respectivos blocos de parafina, dentre os quais foram selecionados somente aqueles que possuíam massa tumoral suficiente para serem realizados cortes adicionais sem que todo o material biológico fosse utilizado. Foram identificadas áreas do sarcoma nos blocos de parafina representativos para a confecção de blocos multiamostrais (microarranjo de tecidos, ou tissue microarray [TMA], em inglês), realizada em instrumento BenchMark ULTRA (Roche Diagnostics Corporation, Indianapolis, IN, USA). Foi então analisada a associação entre a expressão dos marcadores ABCB5, WNT3A e OPN com as variáveis idade, localização e tipo de tecido (teste exato de Fisher/Qui-quadrado). Resultados A média de idade foi de 23 anos, e a incidência de pacientes dos sexos masculino e feminino foi a mesma; foram analisadas 40 lâminas de 28 pacientes com OS, entre 2005 e 2017, com tempo de segmento de 80,0 meses, e o tempo de sobrevida foi de 46,7% em 5 anos. Metástases ocorreram em tecido pulmonar (92,9%). Quanto aos marcadores ABCB5, OPN e WNT3A, não apresentaram significância estatísticas quando comparados com faixa etária, neo-adjuvância e/ou adjuvância quimioterápica, localização, sobrevida ou óbito. O OPN mostrou-se negativo em todas as amostras. E o WNT3A expressou-se nos pacientes com óbitos precoces. Conclusão As proteínas ABCB5, OPN e WNT3A, em estudo imunoistoquímico, não se mostraram presentes com significância estatística. Nos parâmetros analisados, não surgem como sendo fatores preditivos ou de agressividade para o OS.

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BACKGROUND: Therapeutic decision-making regarding surgical treatment of spinal metastasis is supported by clinical characteristics that are potentially predictive of postoperative events. The predictive power of total lymphocyte count (TLC) in peripheral blood has not been elucidated for this type of surgery. Therefore, the aim of this study was to assess the capacity of TLC to predict 30-day morbidity and mortality following surgery for spinal metastases. METHODS: This is a level III prognostic study, which consists of a retrospective review of records from a cancer referral hospital. Consecutive patients who underwent open surgery for spinal metastatic disease were studied. Outcomes of interest were 30-day post-op mortality and complications. The patients were divided into three groups based on preoperative TLC: low, moderate, and high risk for surgery, according to a discriminatory power analysis. The predictive power of TLC was compared to that of other known predictors, i.e., older age, tumor aggressiveness, and presence of comorbidities. Odds ratios (ORs) and 95% confidence intervals were calculated using bivariate and multivariate analyses. RESULTS: In total, 205 patients underwent surgery. Thirty-day mortality and occurrence of complications were 17% and 31%, respectively. The discriminatory power of TLC was 71% and 68% for 30-day survival and complications, respectively. In multivariate analysis, the strongest relationship between predictors and postoperative morbidity and mortality concerned TLC < 800 cells/µL, which was associated with decreased likelihood of 30-day survival (OR 3.17) and increased likelihood of complications (OR 3.93). Incidence of 30-day mortality and complications by risk group was, respectively: 4% and 13% for low risk (TLC > 1857 cells/µL); 22% and 34% for moderate risk (TLC 800-1857 cells/µL); and 35% and 56% for high risk (TLC < 800 cells/µL). CONCLUSIONS: TLC is a strong predictor of 30-day morbidity and mortality following spinal metastasis surgery. It may be useful for improving patient care and planning personalized treatments.

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Objective To develop a predictive model of early postoperative morbidity and mortality with the purpose of assisting in the selection of the candidates for spinal metastasis surgery. Methods A retrospective analysis of consecutive patients operated for metastatic spinal disease. The possible prognostic preoperative characteristics were gender, age, comorbidities, tumor growth rate, and leukocyte and lymphocyte count in the peripheral blood. The postoperative outcomes were 30-day mortality, 90-day mortality and presence of complications. A predictive model was developed based on factors independently associated with these three outcomes. The final model was then tested for the tendency to predict adverse events, discrimination capacity and calibration. Results A total of 205 patients were surgically treated between 2002 and 2015. The rates of the 30-day mortality, 90-day mortality and presence of complications were of 17%, 42% and 31% respectively. The factors independently associated with these three outcomes, which constituted the predictive model, were presence of comorbidities, no slow-growing primary tumor, and lymphocyte count below 1,000 cells/µL. Exposure to none, one, two or three factors was the criterion for the definition of the following categories of the predictive model: low, moderate, high and extreme risk respectively. Comparing the risk categories, there was a progressive increase in the occurrence of outcomes, following a linear trend. The discrimination capacity was of 72%, 73% and 70% for 30-day mortality, 90-day mortality and complications respectively. No lack of calibration occurred. Conclusion The predictive model estimates morbidity and mortality after spinal metastasis surgery and hierarchizes risks as low, moderate, high and extreme.

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OBJECTIVE: To compare preoperative and early postoperative levels of psychosocial distress in patients undergoing bone metastasis treatment with endoprosthesis, evaluating its impact on quality of life. METHODS: Thirteen patients undergoing endoprosthetic treatment of bone metastasis were assessed at two time points: preoperatively and 30 days postoperatively. The tool used was the Distress Thermometer, a questionnaire for psychosocial screening developed by the National Comprehensive Cancer Network. Distress is considered moderate or severe if the patient scores 4 or higher. RESULTS: The most frequent problems in the preoperative period were "bathing and dressing". At 30 days, "fatigue" and "nervousness" prevailed. There was a significant improvement in distress when preoperative and 30-day assessments were compared. CONCLUSION: The surgical treatment of bone metastasis with endoprosthesis results in an early improvement of psychosocial distress as measured by the Distress Thermometer. Level of evidence II, Prospective and comparative therapeutic study.

OBJETIVO: Confrontar o nível de angústia psicossocial (distress) entre o pré-operatório e o pós-operatório precoce de pacientes submetidos ao tratamento de metástase óssea com endoprótese, avaliando seu impacto na qualidade de vida. MÉTODOS: Foram avaliados 13 pacientes submetidos ao tratamento de metástase óssea com endoprótese em dois momentos: pré-operatório e pós-operatório de 30 dias. A ferramenta utilizada foi o termômetro de Distress, questionário de triagem psicossocial desenvolvido pela National Comprehensive Cancer Network. É considerado distress moderado ou grave se o paciente somar 4 ou mais pontos. RESULTADOS: No pré-operatório, os problemas mais frequentes foram "tomar banho e vestir-se". Com 30 dias, os itens mais prevalentes foram "cansaço" e "nervosismo". Houve melhora significativa do distress quando foram comparadas as avaliações pré-operatória e após 30 dias. CONCLUSÃO: O tratamento cirúrgico com endoprótese para metástase óssea reduz precocemente o nível de angústia psicossocial aferido pelo termômetro de Distress. Nível de evidência II, Estudo terapêutico, prospectivo e comparativo.

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Abstract Objective To develop a predictive model of early postoperative morbidity and mortality with the purpose of assisting in the selection of the candidates for spinal metastasis surgery. Methods A retrospective analysis of consecutive patients operated for metastatic spinal disease. The possible prognostic preoperative characteristics were gender, age, comorbidities, tumor growth rate, and leukocyte and lymphocyte count in the peripheral blood. The postoperative outcomes were 30-day mortality, 90-day mortality and presence of complications. A predictive model was developed based on factors independently associated with these three outcomes. The final model was then tested for the tendency to predict adverse events, discrimination capacity and calibration. Results A total of 205 patients were surgically treated between 2002 and 2015. The rates of the 30-day mortality, 90-day mortality and presence of complications were of 17%, 42% and 31% respectively. The factors independently associated with these three outcomes, which constituted the predictive model, were presence of comorbidities, no slow-growing primary tumor, and lymphocyte count below 1,000 cells/µL. Exposure to none, one, two or three factors was the criterion for the definition of the following categories of the predictive model: low, moderate, high and extreme risk respectively. Comparing the risk categories, there was a progressive increase in the occurrence of outcomes, following a linear trend. The discrimination capacity was of 72%, 73% and 70% for 30-day mortality, 90-day mortality and complications respectively. No lack of calibration occurred. Conclusion The predictive model estimates morbidity and mortality after spinal metastasis surgery and hierarchizes risks as low, moderate, high and extreme.

Resumo Objetivo Desenvolver um modelo preditivo de morbimortalidade pós-operatória precoce com o intuito de auxiliar na seleção dos candidatos à cirurgia para metástase vertebral. Métodos Análise retrospectiva de pacientes consecutivos operados por doença metastática vertebral. As características pré-operatórias consideradas possivelmente prognósticas foram: sexo, idade, comorbidades, velocidade de progressão tumoral e contagem de leucócitos e linfócitos no sangue periférico. Os desfechos pós-operatórios analisados foram: mortalidade em 30 dias e em 90 dias, e presença de complicações. Um modelo preditivo foi desenvolvido a partir de fatores independentemente associados a esses três desfechos. Testou-se então o modelo estabelecido quanto à tendência de prever eventos adversos, à capacidade de discriminação e à calibração. Resultados Um total de 205 pacientes foram operados entre 2002 e 2015. A mortalidade em 30 dias e em 90 dias e a incidência de complicações foram de 17%, 42% e 31%, respectivamente. Os fatores independentemente associados a esses três desfechos, e que constituíram o modelo preditivo, foram: presença de comorbidades, tumor primário de progressão não lenta, e linfócitos abaixo de 1.000 células/µL. A exposição a nenhum, um, dois ou três fatores definiu as categorias do modelo preditivo: baixo, moderado, alto e de extremo risco, respectivamente. Comparando-se as categorias, houve aumento progressivo na ocorrência dos desfechos, seguindo tendência linear. A capacidade de discriminação foi de 72%, 73% e 70% para mortalidade em 30 dias, em 90 dias e incidência de complicações, respectivamente. Não ocorreu falta de calibração. Conclusão O modelo preditivo permite estimar a morbimortalidade após a cirurgia para metástase vertebral e hierarquizar os riscos em baixo, moderado, alto e extremo.

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ABSTRACT Objective: To compare preoperative and early postoperative levels of psychosocial distress in patients undergoing bone metastasis treatment with endoprosthesis, evaluating its impact on quality of life. Methods: Thirteen patients undergoing endoprosthetic treatment of bone metastasis were assessed at two time points: preoperatively and 30 days postoperatively. The tool used was the Distress Thermometer, a questionnaire for psychosocial screening developed by the National Comprehensive Cancer Network. Distress is considered moderate or severe if the patient scores 4 or higher. Results: The most frequent problems in the preoperative period were "bathing and dressing". At 30 days, "fatigue" and "nervousness" prevailed. There was a significant improvement in distress when preoperative and 30-day assessments were compared. Conclusion: The surgical treatment of bone metastasis with endoprosthesis results in an early improvement of psychosocial distress as measured by the Distress Thermometer. Level of evidence II, Prospective and comparative therapeutic study.

RESUMO Objetivo: Confrontar o nível de angústia psicossocial (distress) entre o pré-operatório e o pós-operatório precoce de pacientes submetidos ao tratamento de metástase óssea com endoprótese, avaliando seu impacto na qualidade de vida. Métodos: Foram avaliados 13 pacientes submetidos ao tratamento de metástase óssea com endoprótese em dois momentos: pré-operatório e pós-operatório de 30 dias. A ferramenta utilizada foi o termômetro de Distress, questionário de triagem psicossocial desenvolvido pela National Comprehensive Cancer Network. É considerado distress moderado ou grave se o paciente somar 4 ou mais pontos. Resultados: No pré-operatório, os problemas mais frequentes foram "tomar banho e vestir-se". Com 30 dias, os itens mais prevalentes foram "cansaço" e "nervosismo". Houve melhora significativa do distress quando foram comparadas as avaliações pré-operatória e após 30 dias. Conclusão: O tratamento cirúrgico com endoprótese para metástase óssea reduz precocemente o nível de angústia psicossocial aferido pelo termômetro de Distress. Nível de evidência II, Estudo terapêutico, prospectivo e comparativo.

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OBJETIVO: Avaliar os resultados clínicos e radiográficos de pacientes submetidos à corpectomia e fixação com placa cervical, com seguimento de dois anos. MÉTODOS: Análise retrospectiva de 2003 a 2009. Avaliaram-se o tipo de fratura (classificação AO), o grau de déficit neurológico (inicial e após dois anos - escala de Frankel), a taxa de complicações e a taxa de incorporação do enxerto ósseo (de acordo com radiografias dois anos depois da cirurgia). RESULTADOS: Vinte e um pacientes foram avaliados. De acordo com a classificação AO, 14 eram grupo A, 3 B e 4 C. Ao todo, sete pacientes apresentaram déficit neurológico inicial completo (Frankel A) e permaneceram com o déficit neurológico completo após dois anos. Dos seis pacientes que apresentaram déficit neurológico inicial incompleto (Frankel B, C e D), 33% (2 de 6) apresentaram melhora de um nível na escala de Frankel e 50% (3 de 6) deles evoluíram para recuperação completa (Frankel E). Os oito pacientes que não apresentaram lesão neurológica inicial (Frankel E) permaneceram sem déficit neurológico após dois anos. Três complicações clínicas foram verificadas: uma fístula esofágica, uma soltura asséptica do implante e uma infecção no sítio doador de enxerto. Todos os pacientes obtiveram consolidação do enxerto ósseo. CONCLUSÃO: A corpectomia cervical no tratamento da fratura-explosão permite a recuperação neurológica nos pacientes com lesão neurológica incompleta e apresenta baixos índices de complicações.

OBJECTIVE: To evaluate the clinical and radiographic results of patients who underwent corpectomy and cervical plate fixation surgery with two years of follow-up. METHODS: Retrospective analysis from 2003 to 2009. We evaluated the fracture type (AO classification), the degree of neurological deficit (initial and after two years - Frankel scale), the complication rate and the rate of bone graft incorporation (according to X-rays two years after surgery). RESULTS: 21 patients were evaluated. According to the AO classification: 14 were in group A, 3 in B and 4 in C. Overall, seven patients had initial complete neurological deficit (Frankel A) and remained with neurological complete deficit after two years of follow-up. Of the 6 patients who had incomplete initial neurological deficit (Frankel B, C and D), 33% (2 of 6) showed an improvement on the Frankel scale level and 50% (3 of 6) of these progressed to full recovery (Frankel E). The 8 patients without initial neurological injury (Frankel E) remained unaffected after two years. Three clinical complications were observed: an esophageal fistula, an aseptic loosening of the implant and an infection in the graft donor site. All patients had bone graft consolidation. CONCLUSION: Cervical corpectomy in the treatment of burst fractures allows neurological recovery in patients with incomplete neurological injury and has low complication rates.

OBJETIVO: Evaluar los resultados clínicos y radiográficos de los pacientes sometidos a corporectomía y fijación con placa cervical con dos años de seguimiento. MÉTODOS: Análisis retrospectivo desde 2003 hasta 2009. Se evaluó el tipo de fractura (Clasificación AO), el grado de déficit neurológico (inicial y después de 2 años - escala de Frankel), la tasa de complicaciones y la tasa de incorporación del injerto óseo (de acuerdo a los rayos X de dos años de después de la cirugía). RESULTADOS: Veintiún pacientes fueron evaluados. De acuerdo con la clasificación AO, 14 estaban en el grupo A, 3 en el B y en el C. 4 En total, siete pacientes tenían déficit neurológico inicial completo (Frankel A) y mantuvieron el déficit neurológico después de dos años. De los 6 pacientes que tenían déficit neurológico inicial incompleto (Frankel B, C y D), el 33% (2 de 6) mostraron una mejoría en el nivel de escala de Frankel y el 50% (3 de 6) de estas ha progresado hasta la recuperación completa (Frankel E). Los 8 pacientes sin lesión neurológica inicial (Frankel E) no se vieron afectados por déficit neurológico después de dos años. Tres complicaciones clínicas fueron observadas: una fístula, un aflojamiento aséptico del implante y una infección en la zona donante del injerto. Todos los pacientes alcanzaron una consolidación de injerto óseo. CONCLUSIÓN: la corporectomía cervical en el tratamiento de las fracturas por estallido permite la recuperación neurológica de pacientes con lesión incompleta y tiene bajas tasas de complicación.

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