BackgroundThe surgical treatment of upper cervical spine metastases are controversial up to now. By summarizing and analyzing the clinical data of the upper cervical spine involved metastases treated surgically in our center, we mainly aimed to investigate the surgical decisions and outcomes so as to provide more references for the clinical treatment of this special and complex spine metastasis.MethodsWe evaluated the patients’ pre- and post-operative neck pain and neurologic function with paired t test, followed by the statistics of the selection of surgical approaches, ways of reconstruction, and related complications. Moreover, the Kaplan–Meier survival analysis was adopted to analyze the patients’ survival according to different growth group (rapid, moderate, and slow).ResultsThere were 39 patients with atlantoaxial metastases in this study. The most common symptom (94.87%) was occipital-cervical pain, which relieved greatly after surgical interventions (p < 0.01). The metastases mainly resulted from lung cancer and nasopharyngeal cancer with an incidence of 38.46 and 10.26%, respectively. As to different growth group, the rapid-growth tumors accounted for 69.23% in all atlantoaxial metastases. Tumor resection and stabilization were performed mainly via the combined anterior and posterior approach (66.67%). The 1-, 2-, and 3-year overall survival rate at the last follow-up was 58.5, 40, and 28.3%, respectively, with a median survival time of 18 months. The rate of complications associated with the surgical intervention was 12.82% (5/39), which is lower than that of the previous reports and generally controllable.ConclusionsRelatively radical interventions with surgery for upper cervical spine metastases offered satisfactory outcomes with a low mortality. Together with adjuvant therapy, surgical treatment benefits patients with atlantoaxial metastases by relieving regional pain, restoring or improving the neurologic function, stabilizing the quality of life, and prolonging the survival time of such patients.

The expression of microRNA-215 (miR-215) in non-small cell lung cancer (NSCLC) tissues and the effects of miR-215 on the proliferation and migration of NSCLC cells were investigated. qRT-PCR was used to detect the expression of miR-215 in NSCLC tissues and paired normal tumor-adjacent lung tissues; MTT assay, transwell assay and soft-agar assay were used in vitro to evaluate the role of miR-215 on proliferation, migration and cell clonality on NSCLC cells, after transfecting miR-215 mimics to NSCLC cell line A549 or miR-215 to H1299. miR-215 was significantly decreased in NSCLC tissues compared to the paired normal tissues; Overexpression of miR-215 in A549 cells resulted in reduction of the cell proliferation, migration and cell clonality, while downregulation of miR-215 in H1299 cells could promote cell proliferation, migration and clonality. In conclusion, miR-215 was downregulated in NSCLC tissues and may play a key role in the development of NSCLC.

Study Design. A retrospective study. Objective. To describe a new surgical technique for total en bloc spondylectomy (TES) of the fifth lumbar (L5) tumor and evaluate the efficacy and safety of this new technique. Summary of Background Data. TES has been considered an optimal treatment for tumor, including certain spinal tumors, but it requires a combined posterior–anterior approach, which is often complicated by a long operation time, considerable blood loss and severe trauma. Methods. Seven patients with primary or solitary metastatic tumors of L5 were treated with this new technique in our center between March 2014 and November 2017. The critical points were fabrication of the iliac graft, dissection, resection, and reconstruction. Other parameters including surgical time, blood loss, complications, pre- and postoperative neurological function, tumor control, and overall survival (OS) were presented and analyzed. Results. All the included patients received one stage TES. The mean surgical time was 365.7 minutes with an average blood loss of 2514.3 mL. No serious perioperative complication was observed or reported during the mean follow-up period of 27.4 months. Wound disruption occurred in one patient and numbness of the left lower limb in another, but both recovered rapidly after appropriate management. Adventitial avulsion of the abdominal aorta occurred during dissection in one patient. Two patients died during the follow-up period due to advanced malignancy. One patient was alive but developed a newly diagnosed thoracolumbar tumor in 40 months. The other four patients recovered well without evidence of disease. All patients were able to walk independently 3 to 4 weeks after operation, with satisfied fusion of the iliac grafts in a mean period of 6.7 months after operation. No evidence of internal fixation failure occurred. Conclusion. This new technique offers satisfactory surgical exposure, total en bloc spondylectomy, reliable reconstruction, and good tumor control for certain L5 tumors through the posterior-only approach. Level of Evidence: 4

Osteosarcoma (OS) is the most common type of primary bone tumor and accounts for ~60% of all malignant bone tumors in children and adolescents. A large number of studies have proposed that the dysregulated and dysfunctional microRNAs may serve important roles in the occurrence, progression and metastasis of various types of human cancer, including OS. MicroRNA-493 (miR-493) has been identified to act as a tumor suppressor in several types of human cancer. However, little is known regarding the expression pattern and clinical significance of miR-493 in OS. In the present study, reverse transcription-quantitative polymerase chain reaction analysis revealed that miR-493 was markedly downregulated in OS tissues and cell lines and a low miR-493 level were associated with distant metastasis and clinical stage. Furthermore, functional experiments demonstrated that enforced expression of miR-493 led to a significant decrease in OS cell proliferation and invasion . Furthermore, through bioinformatics analysis, specificity protein 1 (SP1) was identified as a direct target gene of miR-493 in OS. Its expression was upregulated in OS tissues and was negatively associated with miR-493 expression levels. Inhibition of SP1 expression also suppressed the proliferation and invasion of OS, exerting a similar effect to that induced by miR-493 overexpression. These results suggested that miR-493 inhibited OS cell proliferation and invasion through negative regulation of SP1. Therefore, miR-493/SP1 may represent a potential therapeutic target for the treatment of OS.

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