Zou Yingjie, Neale Natalie, Sun James, Yang Mo, Bai Harrison Xiao, Tang Lei, Zhang Zishu, Landi Alessandro, Wang Yinyan, Huang Raymond Y, Zhang Paul J, Li Xuejun, Xiao Bo, Yang Li
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan University of Chinese Medicine, Changsha, Hunan, China; Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2018 Oct;118:e375-e387. doi: 10.1016/j.wneu.2018.06.194. Epub 2018 Jun 30.
To investigate prognostic factors of clival chordoma using the largest patient set to date.
Appropriate studies were identified per search criteria, data satisfying criteria were extracted, and survival analysis was performed to investigate prognostic factors of clival chordoma.
A total of 347 patients from the literature cohort met our inclusion criteria. Of 346 cases in which extent of resection was reported, gross total resection (GTR), subtotal resection, and biopsy were achieved in 118 (34.1%), 205 (59.2%), and 21 (6.1%) cases, respectively. Two (0.6%) subjects did not undergo surgery. Of 185 cases in which surgical approach was reported, 56 (30.3%) underwent an endoscopic transoral approach, 17 (9.2%) microscopic transsphenoidal, 45 (24.3%) endoscopic or microscopic, 45 (24.3%) craniotomy, and 22 (11.9%) other approaches. There was no significant difference in GTR rates of different surgical approaches (P = 0.101). Median follow-up was 46.6 months. The 5- and 10-year rates for progression-free survival (PFS) were 59.2% and 47.9%, respectively. The 5- and 10-year rates for overall survival (OS) were 77.3% and 63.9%, respectively. On multivariate analysis for both PFS and OS, GTR demonstrated significantly improved outcomes when compared with subtotal resection (hazard ratio 0.45, 95% confidence interval 0.22-0.90, P = 0.025 for PFS; hazard ratio 0.20, confidence interval 0.06-0.65, P = 0.008 for OS).
GTR rates were comparable in different surgical approaches. GTR was a significant predictor of longer PFS and OS in clival chordoma.
使用迄今为止最大的患者数据集来研究斜坡脊索瘤的预后因素。
根据检索标准确定合适的研究，提取符合标准的数据，并进行生存分析以研究斜坡脊索瘤的预后因素。
文献队列中的347例患者符合我们的纳入标准。在报告了切除范围的346例病例中，分别有118例（34.1%）实现了全切除（GTR）、205例（59.2%）次全切除和21例（6.1%）活检。2例（0.6%）患者未接受手术。在报告了手术入路的185例病例中，56例（30.3%）采用内镜经口入路，17例（9.2%）采用显微镜下经蝶入路，45例（24.3%）采用内镜或显微镜入路，45例（24.3%）采用开颅手术，22例（11.9%）采用其他入路。不同手术入路的GTR率无显著差异（P = 0.101）。中位随访时间为46.6个月。无进展生存期（PFS）的5年和10年率分别为59.2%和47.9%。总生存期（OS）的5年和10年率分别为77.3%和63.9%。在对PFS和OS的多因素分析中，与次全切除相比，GTR显示出显著改善的预后（风险比0.45，95%置信区间0.22 - 0.90，PFS为P = 0.025；风险比0.20，置信区间0.06 - 0.65，OS为P = 0.008）。
不同手术入路的GTR率相当。GTR是斜坡脊索瘤PFS和OS延长的重要预测因素。
