Weng Jian-Cong, Li Da, Li Huan, Ma Jun-Peng, Tian Kai-Bing, Wang Liang, Zhang Li-Wei, Jia Wang, Wu Zhen, Zhang Jun-Ting
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; and Beijing Key Laboratory of Brian Tumor, Beijing, People's Republic of China.
World Neurosurg. 2017 Dec;108:264-277. doi: 10.1016/j.wneu.2017.08.151. Epub 2017 Sep 1.
Management of intracranial chondromas (ICDs) is difficult. This study aims to propose a tailored management strategy based on our management of ICDs.
A retrospective review was performed in 66 patients who received surgical operations at our institute. Clinical charts and radiographs were reviewed, follow-up was performed, and adverse factors for progression-free survival (PFS) and overall survival were evaluated.
The preoperative and postoperative Karnofsky performance status was 81.8 and 72.3, respectively. The mean tumor size was 3.5 cm. Gross total resection was achieved in 15 patients (22.7%). Six patients (10.3%) received postoperative radiation. After a mean follow-up duration of 85.5 months, recurrence occurred to 15 patients (28.8%) with surgery alone, and no recurrence was observed in patients receiving postoperative radiotherapy. Six patients (10.3%) died due to tumor progression. The risk factors affecting the PFS included age <33 years (hazard rate [HR] 6.876; 95% confidence interval [CI] 1.599-29.560; P = 0.010), tumor size ≥3.1 cm (HR 6.138; 95% CI 1.259-29.926; P = 0.025), tumor with evident atypia/mitotic activity (HR 4.672; 95% CI 1.352-16.152; P = 0.015), and partial resection (HR 12.841; 95% CI 3.004-54.896; P = 0.001). In all patients, the PFS rate was 75% at 5 years and 64% at 10 years; in addition, the overall survival rate was 93% at 5 years and 83% at 10 years.
The therapeutic strategy for ICDs should be individualized and should consider preoperative variables. Gross total resection was attempted if the tumors were resectable; otherwise, subtotal resection was an alternative. In patients with partial resection and evident atypia/mitotic activity, consultation with an oncologist for radiotherapy was recommended.
颅内软骨瘤（ICD）的治疗颇具难度。本研究旨在基于我们对ICD的治疗经验，提出一种量身定制的治疗策略。
对在我院接受手术的66例患者进行回顾性研究。查阅临床病历和影像学资料，进行随访，并评估无进展生存期（PFS）和总生存期的不良因素。
术前和术后卡氏功能状态评分分别为81.8和72.3。肿瘤平均大小为3.5厘米。15例患者（22.7%）实现了全切除。6例患者（10.3%）接受了术后放疗。平均随访85.5个月后，单纯手术治疗的患者中有15例（28.8%）复发，接受术后放疗的患者未观察到复发。6例患者（10.3%）因肿瘤进展死亡。影响PFS的危险因素包括年龄<33岁（风险比[HR]6.876；95%置信区间[CI]1.599 - 29.560；P = 0.010）、肿瘤大小≥3.1厘米（HR 6.138；95% CI 1.259 - 29.926；P = 0.025）、具有明显异型性/有丝分裂活性的肿瘤（HR 4.672；95% CI 1.352 - 16.152；P = 0.015）以及部分切除（HR 12.841；95% CI 3.004 - 54.896；P = 0.001）。所有患者中，5年PFS率为75%，10年为64%；此外，5年总生存率为93%，10年为83%。
ICD的治疗策略应个体化，并应考虑术前变量。如果肿瘤可切除，则尝试全切除；否则，次全切除是一种选择。对于部分切除且具有明显异型性/有丝分裂活性的患者，建议咨询肿瘤内科医生进行放疗。
