Department of Orthopedic Surgery, Peking University Third Hospital, Beijing, 100191, China.
AO Clinical Investigation and Documentation, AO Foundation, 8600, Dübendorf, Switzerland.
Ann Surg Oncol. 2017 Aug;24(8):2355-2362. doi: 10.1245/s10434-017-5884-5. Epub 2017 Jun 7.
The recurrence rate of cervical chordomas is high, and hence it is important to discern the prognostic factors for local relapse and overall survival (OS).
A retrospective review of 52 patients with cervical chordoma operated in our institution from January 1999 to March 2015 was performed. The association of clinicopathologic characteristics with local relapse-free survival (LRFS) and OS was analyzed. Univariate analysis was performed to determine whether tumor characteristics and types of therapy affected prognosis, and a multivariate Cox proportional hazard model was developed to further investigate local recurrence and mortality.
Mean follow-up time was 50 months. The cumulative 5- and 10-year LRFS was 35 and 0%, respectively, while the cumulative 5- and 10-year OS was 69 and 53%, respectively. The univariate analysis identified contiguous segments involved, intralesional surgical margin at primary surgery, primary surgery in local hospital, incisional biopsy, and without adjuvant radiotherapy as negative prognostic factors for LRFS, whereas for OS, only tumor location in the upper cervical spine was statistically significant. In the multivariate analysis, contiguous vertebral segments involved, intralesional surgical margins, and incisional biopsy were identified as negative prognostic factors for LRFS, whereas for OS, again only tumor location in the upper cervical spine was statistically significant.
Contiguous vertebral segments involved, intralesional surgical margin, without adjuvant radiotherapy, and incisional biopsy significantly increase local recurrence, while tumor location in the upper cervical spine significantly increases tumor-related mortality. Thus, computed tomography-guided fine-needle aspiration biopsy and total spondylectomy with marginal excision may improve survival of patients with cervical chordoma.
颈椎脊索瘤的复发率较高，因此区分局部复发和总生存（OS）的预后因素很重要。
回顾性分析了 1999 年 1 月至 2015 年 3 月在我院接受治疗的 52 例颈椎脊索瘤患者。分析了临床病理特征与局部无复发生存（LRFS）和 OS 的关系。进行单因素分析以确定肿瘤特征和治疗类型是否影响预后，并建立多因素 Cox 比例风险模型以进一步研究局部复发和死亡率。
平均随访时间为 50 个月。累积 5 年和 10 年 LRFS 分别为 35%和 0%，而累积 5 年和 10 年 OS 分别为 69%和 53%。单因素分析发现连续节段受累、初次手术时的肿瘤内切缘、在当地医院进行的初次手术、切开活检和无辅助放疗是 LRFS 的负预后因素，而对于 OS，仅颈椎上段的肿瘤位置具有统计学意义。在多因素分析中，连续的椎体节段受累、肿瘤内切缘和切开活检被确定为 LRFS 的负预后因素，而对于 OS，再次只有颈椎上段的肿瘤位置具有统计学意义。
连续的椎体节段受累、肿瘤内切缘、无辅助放疗和切开活检显著增加局部复发的风险，而上颈椎的肿瘤位置显著增加肿瘤相关死亡率。因此，CT 引导下细针抽吸活检和边缘切除的全脊椎切除术可能会提高颈椎脊索瘤患者的生存率。
