Analysis of prognostic factors for survival in patients with primary spinal chordoma using the SEER Registry from 1973 to 2014.
Analysis of prognostic factors for survival in patients with primary spinal chordoma using the SEER Registry from 1973 to 2014.
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DOI：
10.1186/s13018-018-0784-3
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发表时间：
2018-04-06
影响因子：
2.6
通讯作者：
Dai Z
中科院分区：
文献类型：
--
作者：
Pan Y;Lu L;Chen J;Zhong Y;Dai Z
脊索瘤是一种罕见的原发骨性肿瘤，起源于脊索的残余物。脊索瘤通常被认为是生长缓慢、局部侵袭性的肿瘤，不易转移，但脊索瘤的高复发率可能严重影响患者的生存率和生活质量。该研究的目的是描述流行病学数据，并确定原发性脊索瘤患者生存率下降的预后因素。监测、流行病学和最终结果（SEER）登记数据库是一个基于美国人群的癌症登记数据库，用于识别1973年至2014年诊断为原发性脊索瘤的所有患者。我们采用Kaplan-Meier法和Cox比例风险回归分析来评估患者总生存率与相关特征（包括年龄、性别、种族、疾病分期、治疗方法、原发肿瘤部位、婚姻状况和城市县背景）之间的关系。在1973年至2014年的数据集中，共有808例患者被确定为原发性脊索瘤。在我们的队列中，远处转移病例的总体发生率仅为7.7%。脊索瘤男性（62.6%）高于女性（37.3%）。大多数肿瘤发生在白色（87.9%），而黑色的发病率相对较少（3.3%）。357例（44.2%）脊索瘤位于脊柱，451例（55.8%）位于骶骨或骨盆。年龄≥60岁（HR = 2.72; 95%CI, 1.71 ~ 2.89）、远处转移（HR = 2.16; 95%CI, 1.54 ~ 3.02）、非手术治疗（HR = 2.14; 95%CI, 1.72 ~ 2.69）是降低生存率的独立危险因素。原发性脊索瘤的生存率在肿瘤部位（椎骨vs骶骨/骨盆）方面没有显著差异（HR = 0.93, P = 0.16）。种族（P = 0.52）、性别（P = 0.11）、婚姻状况（P = 0.94）和城市背景（P = 0.72）不是影响总生存率的主要因素。骶骨脊索瘤与脊柱脊索瘤的总生存率无显著差异。年龄较大（≥60岁）、接受非手术治疗和远处转移的脊索瘤患者的总生存期较差。手术治疗是脊索瘤患者有效可靠的治疗方法，老年脊索瘤远端转移前患者应引起公共卫生部门的重视。
Spinal chordomas are rare primary osseous tumors that arise from the remnants of the notochord. They are commonly considered slow-growing, locally invasive neoplasms with little tendency to metastasize, but the high recurrent rate of spinal chordomas may seriously affect the survival rate and quality of life of patients. The aim of the study is to describe the epidemiological data and determine the prognostic factors for decreased survival in patients with primary spinal chordoma. The Surveillance, Epidemiology, and End Results (SEER) Registry database, a US population-based cancer registry database, was used to identify all patients diagnosed with primary spinal chordoma from 1973 to 2014. We utilized Kaplan–Meier method and Cox proportional hazards regression analysis to evaluate the association between patients overall survival and relevant characteristics, including age, gender, race, disease stage, treatment methods, primary tumor site, marital status, and urban county background. In the data set between 1973 and 2014, a total of 808 patients were identified with primary spinal chordoma. The overall rate of distant metastatic cases in our cohort was only 7.7%. Spinal chordoma was more common occurred in men (62.6%) than women (37.3%). Majority of neoplasms were found in the White (87.9%), while the incidence of the Black is relatively infrequent (3.3%). Three hundred fifty-seven spinal chordomas (44.2%) were located in the vertebral column, while 451 patients’ tumor (55.8%) was located in the sacrum or pelvis. Age ≥ 60 years (HR = 2.72; 95%CI, 1.71 to 2.89), distant metastasis (HR = 2.16; 95%CI, 1.54 to 3.02), and non-surgical therapy (HR = 2.14; 95%CI, 1.72 to 2.69) were independent risk factors for survival reduction in analysis. Survival did not significantly differ as a factor of tumor site (vertebrae vs sacrum/pelvis) for primary spinal chordoma (HR = 0.93, P = 0.16). Race (P = 0.52), gender (P = 0.11), marital status (P = 0.94), and urban background (P = 0.72) were not main factors which affected overall survival rate. There was no significant difference in overall survival rate between chordomas located in the sacrum and vertebral column. Spinal chordoma patients with an elderly age (age ≥ 60), performing non-surgical therapy, and distant metastasis were associated with worse overall survival. Performing surgery was an effective and reliable treatment method for patients with spinal chordoma, and public health efforts should pay more attention to the elderly patients with spinal chordoma prior to distant metastasis.
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