Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2014 Nov;82(5):806-14. doi: 10.1016/j.wneu.2014.07.005. Epub 2014 Jul 5.
Chordomas and chondrosarcomas are rare skull base tumors, with similar radiographic and clinical presentations. We investigated factors influencing long-term survival in these 2 tumors using the Surveillance Epidemiology and End Results (SEER) database.
Patients with chordoma (n = 416) and chondrosarcoma (n = 269) within the skull base from 1983 to 2009 were identified within the SEER database. Kaplan-Meier curves and Cox proportional hazards models were used to test associations with survival. t tests and χ(2) tests were used to compare groups.
Chordoma and chondrosarcoma patients were similar demographically. Survival at 5 years was 65% for chordomas and 81.8% (P < 0.0001) for chondrosarcomas and at 10 years was 32.3% and 49.5% (P = 0.004). Multivariate analysis demonstrated chordomas had a worse prognosis even when we controlled for age and tumor size (hazard ratio 3.0, 95% confidence interval 1.9-4.7, P < 0.0001). For chordomas, multivariate analysis demonstrated increasing age and tumor size were significantly associated with reduced survival. For chondrosarcomas, multivariate analysis demonstrated older age, earlier decade of diagnosis, and mesenchymal subtype were significantly associated with reduced survival. Postoperative radiation was given to 42% and 41% of patients with chordomas and chondrosarcomas, respectively. The addition of radiation did not improve survival.
Consistent with previous case series, skull base chordomas have significantly worse prognosis than chondrosarcomas. Patients in the SEER database had worse survival overall compared with existing case series for both chordomas and chondrosarcomas, suggesting selection bias in the existing literature.
脊索瘤和软骨肉瘤是罕见的颅底肿瘤，具有相似的影像学和临床表现。我们使用监测、流行病学和最终结果（SEER）数据库研究了这两种肿瘤影响长期生存的因素。
在 SEER 数据库中，从 1983 年至 2009 年确定了颅底脊索瘤（n=416）和软骨肉瘤（n=269）患者。使用 Kaplan-Meier 曲线和 Cox 比例风险模型来检验与生存相关的因素。t 检验和 χ(2)检验用于比较组间差异。
脊索瘤和软骨肉瘤患者在人口统计学上相似。脊索瘤患者的 5 年生存率为 65%，软骨肉瘤患者的 5 年生存率为 81.8%（P<0.0001）；10 年生存率分别为 32.3%和 49.5%（P=0.004）。多变量分析表明，即使我们控制了年龄和肿瘤大小，脊索瘤的预后也更差（风险比 3.0，95%置信区间 1.9-4.7，P<0.0001）。对于脊索瘤，多变量分析表明，年龄增加和肿瘤增大与生存率降低显著相关。对于软骨肉瘤，多变量分析表明，年龄较大、诊断较早的十年和间充质亚型与生存率降低显著相关。分别有 42%和 41%的脊索瘤和软骨肉瘤患者接受了术后放疗。放疗的加入并没有改善生存率。
与之前的病例系列研究一致，颅底脊索瘤的预后明显比软骨肉瘤差。SEER 数据库中的患者总体生存率比现有的脊索瘤和软骨肉瘤病例系列研究更差，这表明现有文献中存在选择偏倚。
