Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
Spine (Phila Pa 1976). 2010 Jan 1;35(1):117-23. doi: 10.1097/BRS.0b013e3181b44387.
Retrospective database review using Surveillance, Epidemiology, and End Results database, National Cancer Institute.
To determine current treatment outcomes and demographic characteristics and to define the prognostic factors and impact of surgery on survival.
Rarity of the disease has limited the number of population-based studies addressing the issues of prognostic factors and the current treatment outcomes.
A total of 962 patients with chordoma, diagnosed between 1973 and 2005, were identified in the Surveillance, Epidemiology, and End Results database. Patient demographics and clinical characteristics, incidence, year of diagnosis, location, size and stage at diagnosis, treatment(s), and survival were extracted. Kaplan-Meier, log-rank, and Cox regression were used to analyze the significance of prognostic factors.
Race specific incidence per 100,000 persons in 2005 shows whites to have the highest (0.473) incidence, followed by Asians/Pacific Islanders (0.091), and Afro-Americans (zero), respectively. The incidence difference between whites and Afro-Americans over time is statistically significant (P < 0.001). The age adjusted incidence reveals a peak in eighth decade of life. Survival was not impacted by race. Age category <59, Hispanic ethnicity, size <8 cm, and surgical resection were all independent predictors of better overall survival. Analysis revealed that survival outcomes were very similar in patients with "in-operable disease" and those in which "surgery was recommended but not performed" suggesting that benefits of resection cannot be solely attributed to selection bias.
With high local recurrence rates and the significant functional morbidity associated with surgical resections, clinicians are left wondering if surgery constitutes an appropriate treatment option. Our study clearly demonstrates that surgery significantly improves the overall survival for patients with chordoma. We have further identified age <59 and size of primary tumor <8 cm as important prognostic factors determining the outcome with substantial statistical significance.
使用美国国家癌症研究所监测、流行病学和最终结果数据库进行回顾性数据库研究。
确定当前的治疗结果和人口统计学特征，并确定预后因素以及手术对生存的影响。
由于这种疾病罕见，限制了针对预后因素和当前治疗结果的基于人群的研究数量。
从监测、流行病学和最终结果数据库中确定了 1973 年至 2005 年间诊断的 962 例脊索瘤患者。提取患者的人口统计学和临床特征、发病率、诊断年份、位置、诊断时的大小和分期、治疗方法和生存情况。采用 Kaplan-Meier、log-rank 和 Cox 回归分析来分析预后因素的意义。
2005 年每 10 万人的种族特异性发病率显示，白人的发病率最高（0.473），其次是亚洲/太平洋岛民（0.091），非裔美国人（0）。白人和非裔美国人之间的发病率差异随时间推移具有统计学意义（P < 0.001）。年龄调整后的发病率显示在 80 岁时达到峰值。种族并不影响生存。年龄<59 岁、西班牙裔、肿瘤<8cm 且进行手术切除均是总生存更好的独立预测因素。分析显示，“无法手术的疾病”和“建议手术但未进行”患者的生存结果非常相似，这表明手术切除的获益不能完全归因于选择偏倚。
由于局部复发率高，且与手术切除相关的功能发病率高，临床医生想知道手术是否是一种合适的治疗选择。我们的研究清楚地表明，手术显著改善了脊索瘤患者的总生存率。我们还发现，年龄<59 岁和肿瘤原发灶<8cm 是重要的预后因素，具有显著的统计学意义。
