Factors for Overall Survival in Patients with Skull Base Chordoma: A Retrospective Analysis of 225 Patients
Factors for Overall Survival in Patients with Skull Base Chordoma: A Retrospective Analysis of 225 Patients
复制标题
颅底脊索瘤患者总体生存的因素：225 例患者的回顾性分析
DOI：
10.1016/j.wneu.2016.09.055
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发表时间：
2017-01-01
影响因子：
2
通讯作者：
Wang, Liang
中科院分区：
文献类型：
--
作者：
Tian, Kaibing;Zhang, Haoyu;Wang, Liang
背景技术背景：虽然一个有争议的和复杂的问题，颅底脊索瘤的预后因素是值得exploring.METHODS：与总生存期（OS）的预后因素进行了回顾性估计，在一个单独的队列颅底脊索瘤前瞻性维持10年的Kaplan-Meier方法和单变量考克斯比例风险模型。多因素分析采用考克斯回归分析，以确定独立的预后因素。结果：共纳入180例原发病例和45例复发病例，平均随访时间为43.7个月（范围，4-127个月）。初次组5年和7年的OS分别为84%和78%，平均OS为103.8个月，显著长于复发组，复发后平均OS为68.4个月。在初次手术组中，术前Karnofsky体能状态（KPS）评分（P = 0.004）和围手术期KPS评分下降（P = 0.015）被确定为OS的独立预测因子。一个列线图被用来预测5年和7年OS，该列线图被很好地校准并具有良好的区分能力（校正Harrell C统计量，0.74）。在复发组中，视力缺陷被证实是与复发后OS相关的独立危险因素（P = 0.014）。结论：病理和围手术期KPS评分评估在原发和复发病例的OS预测中具有重要意义。原发性病变的诺模图，包括术前功能状态及其围手术期的变化，似乎对长期生存的危险分层有用。
BACKGROUND: Although a controversial and complex issue, the prognostic factors of skull base chordomas are worth exploring.METHODS: Prognostic factors associated with overall survival (OS) were retrospectively estimated in an individual cohort of skull base chordomas prospectively maintained for 10 years by a Kaplan-Meier method and univariate Cox proportional hazards model. Multivariate analysis by Cox regression analysis was performed to identify the independent prognostic factors. A nomogram was then formulated by R software based on the results.RESULTS: A total of 180 primary patients and 45 recurrent cases were included, with a mean follow-up period of 43.7 months (range, 4-127 months). The OS of the primary group at 5 years and 7 years was 84% and 78%, and the mean OS was 103.8 months, which was significantly longer than the recurrent group, in which the mean postrecurrent OS was 68.4 months. In the primary group, preoperative Karnofsky Performance Status (KPS) score (P = 0.004) and a decline of perioperative KPS score (P = 0.015) were identified as independent predictors of OS. A nomogram was contracted to predict 5-year, and 7-year OS, which was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.74). In the recurrent group, visual deficit was verified as an independent risk factor associated with postrecurrent OS (P = 0.014).CONCLUSIONS: Both pathologic and perioperative KPS score evaluations are significant in OS prediction of both primary and recurrent cases. The nomogram for primary lesions, consisting of preoperative functional status and its perioperative changes, appears useful for risk stratification of long-term survival.