Metastatic disease from spinal chordoma: a 10-year experience
Metastatic disease from spinal chordoma: a 10-year experience
复制标题
DOI：
10.3171/spi.2006.5.4.277
复制
发表时间：
2006-10-01
影响因子：
2.8
通讯作者：
Mendel, Ehud
中科院分区：
文献类型：
--
作者：
McPherson, Chrstopher M.;Suki, Dima;Mendel, Ehud
对象。据报道，在5 - 40%的脊柱和骶尾椎脊索瘤患者中存在转移性病变，但文献中很少有当代脊索瘤转移性疾病的报道。此外，脊索瘤引起的转移性肿瘤患者的预后仍不清楚。作者对位于休斯顿的德克萨斯大学安德森癌症中心的神经外科数据库进行了回顾性分析，以确定当代一系列脊柱和骶尾骨脊索瘤中转移性疾病的发生率，并确定其结果。在1993年6月1日至2004年3月31日期间，37例患者接受了脊柱和骶尾骨脊索瘤手术。回顾所有记录，并采用适当的统计分析来比较患者的术前特征、治疗和结果。作者确定了7例（19%）发生转移性疾病的患者；其中3例仅转移到肺部，2例转移到肺部和肝脏，2例转移到脊柱的远处。有和没有转移的患者在年龄、性别、肿瘤位置或放射治疗史上没有显著差异。在局部复发肿瘤的病例中，转移性疾病的发生比没有复发的患者更容易（28%比0%；p = 0.07）。17例接受整体切除的患者中有2例（12%）发生转移性疾病，而20例接受刮除治疗的患者中有5例（25%）发生转移性疾病（p = 0.42）。使用Kaplan-Meier法计算，从第一次手术到出现转移性疾病的中位时间为143.4个月（95%可信区间[CI] 66.8-219.9）。首次手术后转移性疾病患者的中位生存期为106个月（95% Cl 55.7-155.7），与未发生转移的患者的中位生存期无显著差异（p = 0.93）。在本研究中，19%的患者脊索瘤转移到其他部位。在局部疾病复发的患者中，转移性病变更容易发生。在某些病例中，转移性病变具有侵袭性。手术和化疗可以在控制转移性疾病中发挥作用。
Object. Metastastic lesions have been reported in 5 to 40% of patients with spinal and sacrococcygeal chordoma, but few contemporary series of chordoma metastastic disease exist in the literature. Additionally, the outcome in patients with chordoma-induced metastastic neoplasms remains unclear. The authors performed a retrospective review of the neurosurgery database at the University of Texas M. D. Anderson Cancer Center in Houston to determine the incidence of metastatic disease in a contemporary series of spinal and sacrococcygeal chordoma as well as to determine the outcomes.Methods. Thirty-seven patients underwent surgery for spinal and sacrococcygeal chordoma between June 1, 1993, and March 31, 2004. All records were reviewed, and appropriate statistical analyses were used to compare patient data for preoperative characteristics, treatments, and outcomes.The authors identified seven patients (19%) in whom metastatic disease developed; in three the disease had metastasized to the lungs only, in two to the lungs and liver, and in two to distant locations in the spine. There were no significant differences in age, sex, tumor location, or history of radiation treatments between patients with and those without metastases. In cases with local recurrent tumors, metastastic disease was more likely to develop than in those without recurrence (28 compared with 0%, respectively; p = 0.07). In two (12%) of 17 patients who underwent en bloc resection, metastatic disease developed, whereas it developed in five (25%) of 20 patients treated by curettage (p = 0.42). The median time from first surgery to the appearance of metastatic disease, as calculated using the Kaplan-Meier method, was 143.4 months (95% confidence interval [CI] 66.8-219.9). The median survival duration of patients with metastatic disease after the first surgery was 106 months (95% Cl 55.7-155.7), and this did not differ significantly from that in patients in whom no metastases developed (p = 0.93).Conclusions. Spinal chordoma metastasized to other locations in 19% of the patients in this series. In patients with local disease recurrence, metastatic lesions are more likely to develop. Metastatic lesions were shown to be aggressive in some cases. Surgery and chemotherapy can play a role in controlling metastatic disease.