Ruosi C, Colella G, Di Donato S L, Granata F, Di Salvatore M G, Fazioli F
Orthopaedic Section, Public Health Department, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
Division of Skeletal Muscle Oncology Surgery, National Cancer Institute G. Pascale Foundation, IRCCS, Naples, Italy.
Eur Spine J. 2015 Nov;24 Suppl 7:912-7. doi: 10.1007/s00586-015-4276-4. Epub 2015 Oct 12.
Sacral chordoma is a rare low-to-intermediate grade malignant tumour. The mainstay of treatment is still surgery with en bloc and wide resection margins, which can grant the best chances of a long-term control or cure of this disease. The first aim of this paper is to collect data about survival, time to local recurrence and metastasis among patients affected by sacral chordoma and primarily treated with surgery. The second aim is to analyze the influence of level resection, tumor volume and surgical margins on local recurrence.
The study population was composed of 14 patients treated with sacral chordoma resection at the National Tumour Institute of Naples-Pascale (Italy) from January 2000 to June 2013. The median follow-up was 84 months (range 24-132 months). The follow-up was characterized by: standard radiographs, MRI, and a CT scan of the chest annually. Time to recurrence or metastasis was calculated from the date of resection to the date of diagnosis of first recurrence or metastasis.
Out of all the patients, six died (42.86 %) during the follow-up; 6 (42.86 %) had local recurrence; 4 (28.57 %) had metastasis. At univariate analysis wide surgical margins (R0) were associated with increased survival up to a local recurrence (OR = 0.0286; 95 % CI = 0.0014-0.5739; P = 0.026); the level of resection (OR = 3.33; 95 % CI = 0.3619-30.7025; P = 0.592) and tumour volume (P = 1) did not show a statistically significant correlation.
Based on our experience, we hope all patients to be treated by surgery, the only good standard treatment of this disease. The resection should result in margins as wide as possible. For these reasons, it is essential for this disease to be treated in highly specialized centres because only a complete surgery can offer a chance to care for these patients.
Solid survival at long-term follow-up can be achieved by a surgical resection performed with wide margins.
骶骨脊索瘤是一种罕见的低至中等级别恶性肿瘤。治疗的主要手段仍然是整块切除且切除边缘足够宽的手术，这能为长期控制或治愈该疾病提供最佳机会。本文的首要目的是收集主要接受手术治疗的骶骨脊索瘤患者的生存情况、局部复发时间和转移情况的数据。第二个目的是分析切除水平、肿瘤体积和手术切缘对局部复发的影响。
研究人群包括2000年1月至2013年6月在意大利那不勒斯-帕斯卡莱国家肿瘤研究所接受骶骨脊索瘤切除术的14例患者。中位随访时间为84个月（范围24 - 132个月）。随访包括：每年进行标准X线片、MRI和胸部CT扫描。复发或转移时间从切除日期计算至首次复发或转移诊断日期。
在所有患者中，6例（42.86%）在随访期间死亡；6例（42.86%）出现局部复发；4例（28.57%）发生转移。单因素分析显示，广泛的手术切缘（R0）与至局部复发的生存率提高相关（OR = 0.0286；95% CI = 0.0014 - 0.5739；P = 0.026）；切除水平（OR = 3.33；95% CI = 0.3619 - 30.7025；P = 0.592）和肿瘤体积（P = 1）未显示出统计学显著相关性。
基于我们的经验，我们希望所有患者都接受手术治疗，这是该疾病唯一良好的标准治疗方法。切除应尽可能获得宽切缘。因此，这种疾病在高度专业化的中心进行治疗至关重要，因为只有完整的手术才能为治疗这些患者提供机会。
通过进行宽切缘的手术切除可实现长期随访时的稳固生存。
