脊柱软骨肉瘤患者手术后的条件生存分析。
Conditional Survival Analysis for Spinal Chondrosarcoma Patients After Surgical Resection.
机构信息
Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Orthopaedic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
出版信息
Spine (Phila Pa 1976). 2020 Aug 15;45(16):1110-1117. doi: 10.1097/BRS.0000000000003494.
STUDY DESIGN
Retrospective analysis.
OBJECTIVE
To evaluate conditional survival after surgical resection for spinal chondrosarcoma patients.
SUMMARY OF BACKGROUND DATA
Survival estimates are usually reported as survival from the time of surgery, but survival probabilities can change over time. Conditional survival, which is a measure of prognosis for patients who have survived a defined period of time, may be more clinically precise and relevant. However, data on conditional survival for spinal chondrosarcoma patients after surgical resection are still lacking.
METHODS
We used the Surveillance, Epidemiology, and End Results (SEER) database to identify 436 spinal chondrosarcoma patients who underwent surgical resection from 1994 and 2013. Kaplan-Meier analyses and Cox regression modeling were performed to evaluate prognostic factors associated with overall survival. Five-year conditional survival (i.e., probability of surviving an additional 5 years, given that a patient has already survived x years) was calculated as 5-CS(x) = OS(x+5)/OS(x). The effect of prognostic factors on conditional survival was also explored.
RESULTS
Four hundred thirty six patients were included in the study cohort. Overall, 1-, 3-, and 5-year overall survival were 92.8%, 79.1%, and 70.3%, respectively. Five-year conditional survival at 1, 3, and 5 years after surgery were 72.9%, 79.0%, and 87.5%. The overall survival rates were lower in cases of age more than or equal to 60 years, male patient, dedifferentiated subtype, Grade III tumor, tumor size more than or equal to 10 cm, distant metastasis, and radiotherapy. Conditional survival improved over time in each subgroup divided by age, sex, race, year of diagnosis, grade, tumor size, extent of disease (EOD), and radiotherapy. In addition, patients with the least favorable prognosis at baseline experienced the greatest increase in 5-year conditional survival over time (e.g., Grade I/II: 78.0%-89.7%, Δ11.7% vs. Grade III: 36.5%-66.6%, Δ30.1%; Localized/Regional: 72.9%-88.1%, Δ15.2% vs. Distant: 43.5%-74.1%, Δ30.6%).
CONCLUSION
Conditional survival for spinal chondrosarcoma patients after surgical resection improves over time, especially for patients with initial high-risk characteristics. Information derived from conditional survival analysis may provide individualized approaches to surveillance and treatment of spinal chondrosarcoma.
LEVEL OF EVIDENCE
研究设计
回顾性分析。
目的
评估脊柱软骨肉瘤患者手术后的条件生存情况。
背景数据摘要
生存估计通常报告为从手术时间开始的生存，但生存概率可能随时间而变化。条件生存是一种衡量已经存活特定时间段的患者预后的指标，可能更具有临床精确性和相关性。然而，关于脊柱软骨肉瘤患者手术后的条件生存数据仍然缺乏。
方法
我们使用监测、流行病学和最终结果（SEER）数据库，从 1994 年至 2013 年期间确定了 436 名接受手术切除的脊柱软骨肉瘤患者。进行 Kaplan-Meier 分析和 Cox 回归模型分析，以评估与总生存相关的预后因素。计算 5 年条件生存（即，给定患者已经存活 x 年，那么再存活另外 5 年的概率）为 5-CS(x) = OS(x+5)/OS(x)。还探讨了预后因素对条件生存的影响。
结果
研究队列纳入了 436 名患者。总体而言，1 年、3 年和 5 年的总生存率分别为 92.8%、79.1%和 70.3%。手术后 1、3 和 5 年的 5 年条件生存率分别为 72.9%、79.0%和 87.5%。60 岁及以上、男性、去分化亚型、III 级肿瘤、肿瘤大小≥10cm、远处转移和放疗的患者总生存率较低。年龄、性别、种族、诊断年份、分级、肿瘤大小、疾病程度（EOD）和放疗的每个亚组中，条件生存随时间改善。此外，基线预后最差的患者在随访期间 5 年条件生存率的提高幅度最大（例如，I/II 级：78.0%-89.7%，Δ11.7%比 III 级：36.5%-66.6%，Δ30.1%；局部/区域：72.9%-88.1%，Δ15.2%比远处转移：43.5%-74.1%，Δ30.6%）。
结论
脊柱软骨肉瘤患者手术后的条件生存随时间改善，特别是对于初始高风险特征的患者。条件生存分析得出的信息可以为脊柱软骨肉瘤的监测和治疗提供个体化方法。
证据水平
4。
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