Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Orthopaedics, The Affiliated Hospital of Jiujiang Medical College, Jiujiang, Jiangxi, China.
World Neurosurg. 2019 Aug;128:e603-e614. doi: 10.1016/j.wneu.2019.04.217. Epub 2019 May 1.
Chordoma is a type of rare bone tumor and is a relatively slow-growing, low-grade malignancy that is locally invasive and aggressive. The nomogram is widely used in the field of cancer because it can provide a clear picture for clinicians to predict the survival rate, which can lead more accurate decisions in clinical treatment.
Overall, 875 patients with a primary spinal chordoma were identified and collected from the Surveillance, Epidemiology, and End Results registry databases (1973-2015). The nomogram was established based on 425 patients with complete data. The predictive accuracy and discriminative ability of the nomogram were determined by the concordance index (C-index) and calibration curve.
The statistical nomogram was built on 10 independent prognostic factors: age, sex, race, disease stage, surgery, year of diagnosis, marital status, primary site, radiation, and tumor size, with C-indices of 0.76. The calibration curve to determine the probability of survival showed good agreement between the predictions by the nomogram and actual observation. Tumor diameter >10 cm (hazard ratio [HR] 2.95, 95% confidence interval [CI] 1.77-4.90, P < 0.001), regional invasive (HR 1.71, 95% CI 1.16-2.53, P < 0.01), and distant metastasis (HR 3.44, 95% CI 1.98-5.96, P< 0.001) were independent risk factors for poor survival. Undergoing subtotal resection or gross total resection (HR 0.37, 95% CI 0.25-0.56, P < 0.001; HR 0.26, 95% CI 0.17-0.41, respectively) and a primary site located in the sacrum/pelvis (HR 0.51, 95% CI 0.34-0.78, P < 0.01) were prognostic factors for better survival.
The nomogram provided more accurate prognostic predictions for patients with spinal chordoma. Moreover, our study suggests that tumor diameter >5 cm, distant metastasis, and not performing resection are major risk factors that can dramatically decrease the survival time of patients with spinal chordoma.
脊索瘤是一种罕见的骨肿瘤，属于生长缓慢、低度恶性的肿瘤，具有局部侵袭性和侵袭性。列线图在癌症领域得到了广泛应用，因为它可以为临床医生提供清晰的图像，预测生存率，从而在临床治疗中做出更准确的决策。
从监测、流行病学和结果登记数据库（1973-2015 年）中总共确定并收集了 875 例原发性脊柱脊索瘤患者。根据 425 例完整数据建立了列线图。通过一致性指数（C 指数）和校准曲线确定列线图的预测准确性和判别能力。
基于 10 个独立的预后因素构建了统计列线图：年龄、性别、种族、疾病分期、手术、诊断年份、婚姻状况、原发部位、放疗和肿瘤大小，C 指数为 0.76。确定生存率概率的校准曲线显示，列线图预测与实际观察结果吻合良好。肿瘤直径>10cm（风险比[HR]2.95，95%置信区间[CI]1.77-4.90，P<0.001）、区域侵袭（HR 1.71，95%CI 1.16-2.53，P<0.01）和远处转移（HR 3.44，95%CI 1.98-5.96，P<0.001）是生存不良的独立危险因素。次全切除或大体全切除（HR 0.37，95%CI 0.25-0.56，P<0.001；HR 0.26，95%CI 0.17-0.41）和原发部位位于骶骨/骨盆（HR 0.51，95%CI 0.34-0.78，P<0.01）是生存的预后因素。
列线图为脊柱脊索瘤患者提供了更准确的预后预测。此外，我们的研究表明，肿瘤直径>5cm、远处转移和未行切除术是主要的危险因素，可显著降低脊柱脊索瘤患者的生存时间。
