Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients
Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients
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DOI：
10.1038/sc.2009.95
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发表时间：
2010-02-01
期刊：
影响因子：
2.2
通讯作者：
Chen, X. Q.
中科院分区：
文献类型：
--
作者：
Chen, K. W.;Yang, H. L.;Chen, X. Q.
研究设计：回顾性研究。目的：探讨影响骶椎脊索瘤预后的因素，为提高患者的持续无病生存期提供理论依据。方法：1992-2007年间，36例患者接受了初次手术。对年龄、性别、肿瘤大小、肿瘤部位、手术类型、手术切缘、周围肌肉侵犯、放射治疗和复发等资料进行统计分析。结果：平均随访时间74.4个月(16-182个月)。16例患者在最后一次随访时出现局部复发。复发时间3~84个月，平均30个月。5年期和10年期精算CDF分别为59.5%和42%。肿瘤最高值在S3以下的患者CDF明显长于S3以上的患者(P=0.047)。有周围肌肉侵犯的患者CDF短于无周围肌肉侵犯的患者(P-0.014)。统计学分析显示，手术类型是影响CDF的最有价值的指标(P=0.001)。切缘不足时，局部复发率在统计学上更高(P=0.021)。COX多因素回归分析显示，肿瘤侵犯周围肌肉(P=0.024)是影响CDF预后的独立因素，而不完全切除(P=0.056)对CDF预后影响不大。结论：肿瘤侵犯程度高、侵犯周围肌肉、切除不彻底、手术切缘不充分是预后不良的因素。完全切除肿瘤并扩大手术切缘可能会为这些患者提供更好的预后。脊髓(2010年)48,166171；doi：10.1038/sc.2009.95；2009年7月21日在线发布
Study design: Retrospective study.Objectives: To investigate prognostic factors of sacral chordomas and provide theoretical foundation for an improvement of continuous disease-free survival (CDFS).Methods: Thirty-six patients underwent initial operation for sacral chordoma between 1992 and 2007. Data regarding age, gender, tumor size, tumor location, and type of surgery, surgical margins, surrounding muscle invasion, radiation therapy, and recurrences were reviewed and analyzed statistically.Results: The average duration of follow-up was 74.4 months (range, 16-182 months). Sixteen patients developed local recurrences at the time of final follow-up. The average recurrence time was 30 months (range, 3-84 months). The 5-year and 10-year actuarial CDFS were 59.5 and 42%, respectively. CDFS was found statistically longer in patients whose tumor highest level at or below S3 compared with above S3 (P = 0.047). Patients who had invasion into the surrounding muscle had a shorter CDFS than those without surrounding muscle invasion (P - 0.014). Statistic analysis showed that the type of surgery was the most valuable indicator of CDFS (P = 0.001). The local recurrence rate was statistically higher when an inadequate margin has been achieved (P = 0.021). The Cox multivariate regression analysis showed that surrounding muscle invasion (P = 0.024) was an independent adverse prognostic factor for CDFS, whereas incomplete excision (P = 0.056) achieved borderline significance.Conclusions: The higher level of tumor involvement, invasion into the surrounding muscle, incomplete excision, and inadequate surgical margins are poor prognostic factors. Resecting the tumor completely with wide surgical margins may provide a better prognosis for these patients. Spinal Cord (2010) 48, 166-171; doi: 10.1038/sc.2009.95; published online 21 July 2009