York J E, Berk R H, Fuller G N, Rao J S, Abi-Said D, Wildrick D M, Gokaslan Z L
Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
J Neurosurg. 1999 Jan;90(1 Suppl):73-8. doi: 10.3171/spi.1999.90.1.0073.
Primary chondrosarcoma of the spine is extremely rare. During the last 43 years only 21 patients with this disease were registered at The University of Texas M. D. Anderson Cancer Center. The purpose of this study was to examine the demographic characteristics, treatments, and outcomes of this set of patients.
Medical records for 21 patients were reviewed. Age, sex, race, clinical presentation, tumor histology, tumor location in the spinal column, treatments, surgical details, and response to treatment were recorded. Surgical procedures were categorized as either gross-total resection or subtotal excision of tumor. Neurological function was assessed using Frankel's functional classification. Time to recurrence and survival analyses were performed using the Kaplan-Meier method. The median age of patients was 51 years, with fairly equal gender representation. Eighteen patients underwent at least one surgical procedure for a total of 28 surgical procedures: seven radical resections and 21 subtotal excisions. Radiation therapy was used in conjunction with 10 of the 28 surgical procedures. The median Kaplan-Meier estimate of overall survival for the entire group was 6 years (range 6 months-17 years). Tumors recurred after 18 of the 28 procedures. Kaplan-Meier analysis revealed a statistically significant difference in the per-procedure disease-free interval after gross-total resection relative to subtotal excision (exact log rank 3.39; p = 0.04). The addition of radiation therapy prolonged the median disease-free interval from 16 to 44 months, although this was not statistically significant (exact log rank 2.63; p = 0.16).
Our results suggest that gross-total resection of the chondrosarcoma provides the best chance for prolonging the disease-free interval in patients. Subtotal excision should be avoided whenever possible. Addition of radiation therapy does not appear to lengthen significantly the disease-free interval in this patient population.
脊柱原发性软骨肉瘤极为罕见。在过去43年中，德克萨斯大学MD安德森癌症中心仅登记了21例患有这种疾病的患者。本研究的目的是检查这组患者的人口统计学特征、治疗方法和结果。
回顾了21例患者的病历。记录了年龄、性别、种族、临床表现、肿瘤组织学、肿瘤在脊柱中的位置、治疗方法、手术细节和对治疗的反应。手术程序分为肿瘤全切除或次全切除。使用Frankel功能分类评估神经功能。采用Kaplan-Meier方法进行复发时间和生存分析。患者的中位年龄为51岁，性别分布相当均衡。18例患者至少接受了一次手术，共进行了28次手术：7次根治性切除和21次次全切除。28次手术中有10次联合使用了放射治疗。整个组的总体生存的中位Kaplan-Meier估计值为6年（范围为6个月至17年）。28次手术中有18次肿瘤复发。Kaplan-Meier分析显示，相对于次全切除，全切除术后每个手术的无病间期存在统计学上的显著差异（精确对数秩检验为3.39；p = 0.04）。放射治疗的加入将中位无病间期从16个月延长至44个月，尽管这在统计学上不显著（精确对数秩检验为2.63；p = 0.16）。
我们的结果表明，软骨肉瘤的全切除为延长患者的无病间期提供了最佳机会。应尽可能避免次全切除。在这一患者群体中，加入放射治疗似乎并不能显著延长无病间期。
