Surgical treatment of sacral chordoma: survival and prognostic factors
Surgical treatment of sacral chordoma: survival and prognostic factors
复制标题
DOI：
10.1007/s00586-015-4276-4
复制
发表时间：
2015-11-01
影响因子：
2.8
通讯作者：
Fazioli, F.
中科院分区：
文献类型：
--
作者：
Ruosi, C.;Colella, G.;Fazioli, F.
摘要骶脊索瘤是一种罕见的低中度恶性肿瘤。主要的治疗方法仍然是手术，整体切除和大切除边缘，这可以提供长期控制或治愈这种疾病的最佳机会。本文的第一个目的是收集以手术为主的骶脊索瘤患者的生存、局部复发和转移时间的数据。二是分析水平切除、肿瘤体积和手术切缘对局部复发的影响。材料和方法研究人群由2000年1月至2013年6月在意大利那不勒斯-帕斯卡尔国家肿瘤研究所接受骶骨脊索瘤切除术的14例患者组成。中位随访时间为84个月（24-132个月）。随访的特点是：标准x线片、MRI和每年一次胸部CT扫描。复发或转移的时间从切除之日起计算至诊断首次复发或转移之日。结果随访期间死亡6例（42.86%）；局部复发6例（42.86%）；4例（28.57%）有转移。在单因素分析中，手术切缘宽（R0）与生存率增加相关，直至局部复发（OR = 0.0286; 95% CI = 0.0014-0.5739; P = 0.026）；切除水平OR = 3.33；95% ci = 0.3619-30.7025；P = 0.592)与肿瘤体积（P = 1）的相关性无统计学意义。根据我们的经验，我们希望所有的患者都能接受手术治疗，这是治疗本病唯一好的标准方法。切除后应使切缘尽可能宽。由于这些原因，这种疾病必须在高度专业化的中心进行治疗，因为只有进行完整的手术才能提供照顾这些患者的机会。结论采用大切缘手术切除可获得长期随访的可靠生存。
Introduction Sacral chordoma is a rare low-to-intermediate grade malignant tumour. The mainstay of treatment is still surgery with en bloc and wide resection margins, which can grant the best chances of a long-term control or cure of this disease. The first aim of this paper is to collect data about survival, time to local recurrence and metastasis among patients affected by sacral chordoma and primarily treated with surgery. The second aim is to analyze the influence of level resection, tumor volume and surgical margins on local recurrence.Materials and methods The study population was composed of 14 patients treated with sacral chordoma resection at the National Tumour Institute of Naples-Pascale (Italy) from January 2000 to June 2013. The median follow-up was 84 months (range 24-132 months). The follow-up was characterized by: standard radiographs, MRI, and a CT scan of the chest annually. Time to recurrence or metastasis was calculated from the date of resection to the date of diagnosis of first recurrence or metastasis.Results Out of all the patients, six died (42.86 %) during the follow-up; 6 (42.86 %) had local recurrence; 4 (28.57 %) had metastasis. At univariate analysis wide surgical margins (R0) were associated with increased survival up to a local recurrence (OR = 0.0286; 95 % CI = 0.0014-0.5739; P = 0.026); the level of resection OR = 3.33; 95 % CI = 0.3619-30.7025; P = 0.592) and tumour volume (P = 1) did not show a statistically significant correlation. Discussion Based on our experience, we hope all patients to be treated by surgery, the only good standard treatment of this disease. The resection should result in margins as wide as possible. For these reasons, it is essential for this disease to be treated in highly specialized centres because only a complete surgery can offer a chance to care for these patients.Conclusions Solid survival at long-term follow-up can be achieved by a surgical resection performed with wide margins.