Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, Zhejiang, 325027, China.
J Orthop Surg Res. 2019 Jun 17;14(1):181. doi: 10.1186/s13018-019-1225-7.
To evaluate the conditional survival of patients with chordoma to potentially help physician planning of optimal cancer surveillance and guide better clinical decisions.
In total, 1942 patients with chordoma were identified and extracted from Surveillance, Epidemiology, and End Results (SEER) databases (1973-2015). The cumulative survival estimates were used to calculate the conditional survival rate, and the Greenwood formula was used to estimate the 95% CI. In addition, multivariable Cox regression analyses were used to calculate hazard ratios, according to the duration of survival.
The conditional 5-year disease-specific survival in patients with regional or localized chordoma was relatively stable over time, whereas in patients with distant chordoma, there was a gradual improvement. The conditional 5-year disease-specific survival (DSS) of patients older than 60 years old and patients with a tumor size between 5 and 10 cm improved. Interestingly, for patients with a tumor larger than 10 cm, the conditional 5-year DSS decreased over time. After surviving 5 years, the hazard ratio (HR) of patients older than 60 years old decreased from 1.33 to 1.24, that of patients with a tumor size between 5 and 10 cm decreased from 1.61 to 1.52 and that of patients with distant metastasis decreased from 3.30 to 1.09. However, after surviving 5 years, the HR of patients with a tumor size larger than 10 cm increased from 2.33 to 3.77, that of patients who underwent surgical resection increased from 0.37 to 0.58 and that of patients who received radiation therapy increased from 0.81 to 1.04.
Age at diagnosis, tumor size and disease stage can influence conditional survival for patients with chordoma. The HR of different factors will change over the survival time. Therefore, understanding the changing risk profile and conditional 5-year DSS of chordoma is critical for accurate clinical treatment guidance.
评估脊索瘤患者的条件生存情况，以帮助医生规划最佳癌症监测并指导更好的临床决策。
共从监测、流行病学和最终结果（SEER）数据库（1973-2015 年）中提取了 1942 例脊索瘤患者的数据。使用累积生存估计来计算条件生存率，并使用 Greenwood 公式估计 95%CI。此外，根据生存时间，使用多变量 Cox 回归分析计算危险比。
局部或局限性脊索瘤患者的 5 年疾病特异性生存的条件率在时间上相对稳定，而远处转移的脊索瘤患者的条件率则逐渐改善。60 岁以上患者和肿瘤大小在 5-10cm 之间的患者的 5 年疾病特异性生存（DSS）得到改善。有趣的是，对于肿瘤大于 10cm 的患者，5 年条件 DSS 随时间而降低。在存活 5 年后，60 岁以上患者的危险比（HR）从 1.33 降至 1.24，肿瘤大小在 5-10cm 之间的患者的 HR 从 1.61 降至 1.52，远处转移的患者的 HR 从 3.30 降至 1.09。然而，在存活 5 年后，肿瘤大小大于 10cm 的患者的 HR 从 2.33 增加到 3.77，接受手术切除的患者的 HR 从 0.37 增加到 0.58，接受放射治疗的患者的 HR 从 0.81 增加到 1.04。
诊断时的年龄、肿瘤大小和疾病分期会影响脊索瘤患者的条件生存。不同因素的 HR 会随生存时间而变化。因此，了解脊索瘤的变化风险概况和 5 年条件 DSS 对于准确的临床治疗指导至关重要。
