Meng Tong, Yin Huabin, Li Bo, Li Zhenxi, Xu Wei, Zhou Wang, Cheng Mo, Wang Jing, Zhou Lei, Yang Xinghai, Liu Tielong, Yan Wangjun, Song Dianwen, Xiao Jianru
Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai China (T.M., H.Y., B.L., Z.L., W.X., W.Z., M.C., J.W., L.Z., X.Y., T.L., W.Y., D.S., J.X.).
Neuro Oncol. 2015 May;17(5):725-32. doi: 10.1093/neuonc/nou331. Epub 2014 Dec 8.
Chordoma in the spine is relatively rare, and minimal information has been published in the literature regarding this subject. Moreover, there are controversies over prognostic factors of this disease.
A retrospective analysis of chordoma in the spine was performed by survival analysis. Local relapse-free survival (LRFS) and overall survival (OS) were analyzed from the date of surgery to the date of local recurrence and death. The LRFS and OS rates were estimated using the Kaplan-Meier method to identify potential prognostic factors. Factors with P values ≤ .1 were subjected to multivariate analysis by Cox regression analysis. P values ≤ .05 were considered statistically significant.
A total of 153 patients with spinal chordoma were included in the study. The mean follow-up period was 72.0 months (range, 1-279 months). Local recurrence was detected in 51 cases after initial surgery in our center, while death occurred in 42 cases. The statistical analysis suggested that tumor location of C3-L5, dedifferentiated chordoma, preoperative Frankel scores A-C, and total spondylectomy were independent prognostic factors for LRFS. In addition, total en bloc spondylectomy and Karnofsky' performance status (KPS) ≥ 80% were favorable factors for OS.
Total spondylectomy, by either en bloc or piecemeal method, could significantly reduce LRFS for spinal chordoma. Location of C3-L5 is a favorable factor for LRFS, while dedifferentiated subtype and preoperative Frankel scores A-C are adverse prognostic factors. In addition, total en bloc spondylectomy and KPS ≥ 80% significantly improve overall survival of patients with spinal chordoma.
脊柱脊索瘤相对罕见，关于这一主题的文献报道较少。此外，该疾病的预后因素存在争议。
采用生存分析对脊柱脊索瘤进行回顾性分析。从手术日期至局部复发和死亡日期分析局部无复发生存期（LRFS）和总生存期（OS）。使用Kaplan-Meier方法估计LRFS和OS率，以确定潜在的预后因素。P值≤0.1的因素通过Cox回归分析进行多因素分析。P值≤0.05被认为具有统计学意义。
本研究共纳入153例脊柱脊索瘤患者。平均随访时间为72.0个月（范围1 - 279个月）。在我们中心，初次手术后51例出现局部复发，42例死亡。统计分析表明，C3 - L5节段的肿瘤位置、去分化脊索瘤、术前Frankel评分A - C以及全脊椎切除术是LRFS的独立预后因素。此外，整块全脊椎切除术和卡诺夫斯基性能状态（KPS）≥80%是OS的有利因素。
整块或分块全脊椎切除术均可显著降低脊柱脊索瘤的LRFS。C3 - L5节段是LRFS的有利因素，而去分化亚型和术前Frankel评分A - C是不良预后因素。此外，整块全脊椎切除术和KPS≥80%可显著提高脊柱脊索瘤患者的总生存期。
