Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Spine (Phila Pa 1976). 2009 Nov 15;34(24):2700-4. doi: 10.1097/BRS.0b013e3181bad11d.
Retrospective case series.
The purpose of this study was to evaluate factors that contribute to improved local control and survival. In addition, we sought to define the expected morbidity associated with treatment.
Sacral chordomas are rare tumors presumed to arise from notochordal cells. Local recurrence presents a major problem in the management of these tumors and it has been correlated with survival. Resection of sacral tumors is associated with significant morbidity.
Forty-two patients underwent resection for sacral chordoma between 1990 and 2005. Twelve patients had their initial surgery elsewhere. There were 12 female and 30 male patients. The proximal extent of the sacrectomy was at least S2 in 32 patients.
Median survival was 84 months, and 5-year disease-free (DFS) and disease-specific survival (DSF) were 56% and 77%, respectively. Local recurrence (LR) and metastasis occurred in 17 (40%) and 13 (31%) patients, respectively. Local recurrence (P=0.0001), metastasis (P=0.0001), prior resection (P=0.046), and higher grade (P=0.05) were associated with a worse DSF. Prior resections (P=0.0001) and intralesional resections (P=0.01) were associated with a higher rate of LR. Intralesional resections were associated with a lower DSF (P=0.0001). Wide contaminated margins treated with cryosurgery and/or radiation were not associated with a higher LR rate. Rectus abdominus flaps were associated with decreased wound complications (P=0.01). Thirty-one (74%) patients reported that they self catheterize; and 16 (38%) patients required bowel training, while an additional twelve (29%) patients had a colostomy. Twenty-eight (67%) patients reported sexual dysfunction. Two (5%) patients died due to sepsis.
Intralesional resection should be avoided as it is associated with a higher LR rate and worse survival. Rectus abdominus flaps ought to be considered as they lower the wound complication rate. Sacral resection is associated with significant morbidity.
回顾性病例系列研究。
本研究旨在评估有助于提高局部控制率和生存率的因素。此外，我们还试图确定与治疗相关的预期发病率。
骶尾部脊索瘤是一种罕见的肿瘤，被认为起源于脊索细胞。局部复发是这些肿瘤治疗中的一个主要问题，与生存率相关。骶骨肿瘤切除术与显著的发病率相关。
1990 年至 2005 年间，42 例骶骨脊索瘤患者接受了切除术。12 例患者在其他地方进行了初次手术。其中女性 12 例，男性 30 例。32 例患者的骶骨切除术近端至少达到 S2 水平。
中位生存期为 84 个月，5 年无疾病生存率（DFS）和疾病特异性生存率（DSF）分别为 56%和 77%。17 例（40%）和 13 例（31%）患者分别发生局部复发（LR）和转移。局部复发（P=0.0001）、转移（P=0.0001）、既往切除（P=0.046）和较高分级（P=0.05）与较差的 DSF 相关。既往切除（P=0.0001）和肿瘤内切除（P=0.01）与更高的 LR 率相关。肿瘤内切除与较低的 DSF 相关（P=0.0001）。经冷冻手术和/或放射治疗处理的广泛污染边缘并未导致更高的 LR 率。腹直肌皮瓣与减少伤口并发症相关（P=0.01）。31 例（74%）患者报告他们自行导尿；16 例（38%）患者需要进行肠道训练，而另外 12 例（29%）患者有结肠造口术。28 例（67%）患者报告存在性功能障碍。2 例（5%）患者因脓毒症死亡。
肿瘤内切除应避免，因为它与更高的 LR 率和更差的生存率相关。应考虑使用腹直肌皮瓣，因为它们降低了伤口并发症的发生率。骶骨切除术与显著的发病率相关。
