Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, Box 0112, San Francisco, CA 94143, USA.
Spine J. 2009 Nov;9(11):928-35. doi: 10.1016/j.spinee.2009.07.005. Epub 2009 Aug 28.
Survival data and rates of recurrence after en bloc resection for cervical spinal tumors are limited to single case reports and small case series, making the true risk of recurrence after this procedure unknown.
To report two cases of cervical chordoma managed via en bloc resection. To conduct a systematic review of the existing literature to determine the overall incidence of disease-free survival and investigate potential prognostic factors of recurrence.
Case report and systematic review.
We present the cases of a 60-year-old woman and a 76-year-old man who underwent en bloc resection of C3-C6 and C2 chordomas, respectively. A complete MEDLINE search was then undertaken for all articles reporting survival data for en bloc resections of primary tumors of the cervical spine. Exclusion criteria included non-English articles, lack of explicit mention or description of en bloc technique, age less than 16, no demographic or survival information reported, and follow-up less than 1 month. Survivorship analysis was conducted, and Kaplan-Meier plots were created with the primary outcome of interest being any tumor recurrence.
A total of 10 articles comprising 18 cases were included for analysis with a mean follow-up of 47.4+/-41.5 months. Mean operative time, estimated blood loss, and length of hospitalization were 18.6 hours, 2.9L, and 34.6 days, respectively. Postoperative complications occurred in eight of the nine patients in which these data were reported. There were three cases of local recurrence, occurring at 12, 44, and 113 months, and one case of distant metastasis, occurring at 12 months postoperatively. With the available data, 1- and 5-year disease-free survival rates of 88.2% and 73.5% were calculated. On Cox proportional hazards analysis, no factors were found to be predictive of recurrence.
In this systematic review of the literature, en bloc resection provided good disease-free survival rates in patients with primary tumors of the cervical spine. However, there are insufficient data on long-term subjective outcomes in these patients, and larger series are needed to determine the efficacy compared with piecemeal resection techniques. Other investigators should be encouraged to publish their results so that combined analyses like these may be performed with larger sample sizes.
颈椎肿瘤整块切除术后的生存数据和复发率仅限于单个病例报告和小病例系列，因此无法了解该手术的真实复发风险。
报告两例颈椎脊索瘤患者通过整块切除术进行治疗。对现有文献进行系统回顾，以确定无病生存率的总体发生率，并研究复发的潜在预后因素。
病例报告和系统回顾。
我们介绍了一位 60 岁女性和一位 76 岁男性的病例，他们分别接受了 C3-C6 和 C2 脊索瘤的整块切除术。然后对所有报告颈椎原发肿瘤整块切除术生存数据的文章进行了全面的 MEDLINE 搜索。排除标准包括非英语文章、缺乏明确提及或描述整块技术、年龄小于 16 岁、未报告人口统计学或生存信息、随访时间少于 1 个月。进行了生存分析，并绘制了Kaplan-Meier 图，主要观察终点为任何肿瘤复发。
共纳入 10 篇文章 18 例患者进行分析，平均随访时间为 47.4+/-41.5 个月。平均手术时间、估计失血量和住院时间分别为 18.6 小时、2.9L 和 34.6 天。在报告这些数据的 9 例患者中，有 8 例发生术后并发症。有 3 例局部复发，发生在 12、44 和 113 个月，1 例远处转移，发生在术后 12 个月。根据现有数据，计算出 1 年和 5 年无病生存率分别为 88.2%和 73.5%。在 Cox 比例风险分析中，未发现任何因素与复发相关。
在对文献的系统回顾中，整块切除术为颈椎原发肿瘤患者提供了良好的无病生存率。然而，这些患者的长期主观结局数据不足，需要更大的系列来确定与分块切除术技术相比的疗效。应鼓励其他研究人员发表他们的结果，以便能够进行更大样本量的合并分析。
