Department of Neurosurgery, Humanitas Clinical and Research Hospital and Humanitas University, Viale Alessandro Manzoni 56, Rozzano, Milan, Italy.
Department of Neurosurgery IRCCS Neuromed, Pozzilli, Italy.
Neurosurg Rev. 2021 Jun;44(3):1217-1225. doi: 10.1007/s10143-020-01318-y. Epub 2020 May 29.
Chordoma is a rare slow-growing neoplastic bone lesion. However, they show an invasive local growth and high recurrence rate, leading to an overall survival rate of 65% at 5 years and 35% at 10 years. We conducted a pooled and meta-analysis comparing recurrence rate, post-operative-complications, and survival in patients undergoing either microsurgical (MA) or endoscopic approaches (EA). Search of literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify surgical series of clivus chordomas published between January 1990 and March 2018 on Pubmed, Scopus, and Cochrane. Two different statistical analyses have been performed: a pooled analysis and a single-arm meta-analysis of overall recurrence rate and subgroup meta-analysis of complications in the subgroups open surgery and endoscopic surgery. After full-text screening, a total of 58 articles were included in the pooled analysis and 27 studies were included for the study-level meta-analysis. Pooled analysis-the extent of resection was the only association that remained significant (subtotal: HR = 2.18, p = 0.004; partial: HR = 4.40, p < 0.001). Recurrence was more prevalent among the surgical patients (45.5%) compared to endoscopic ones (23.7%). Meta-analysis-results of the cumulative meta-analysis showed an overall rate of recurrence of 25.6%. MA recurrence rate was 31.8% (99% CI 14-52.8), EA recurrence rate was 19.4% (5.4-39.2). CSF leak rate for the endoscopic group was 10.3% (99%CI 5-17.3) and 9.5% (99%CI 1.2-24.6) for the open surgery group. The partial removal versus total removal has an influence on recurrence rate (p < 0.001). MA recurrence rate was 31.8%; EA recurrence rate was 19.4%. The extent of resection is confirmed as a statistically significant factor affecting the risk for recurrence both with the pooled analysis and with the meta-analysis. Meta-analysis demonstrated that older patients tend to recur more than young patients, especially in surgical group.
脊索瘤是一种罕见的生长缓慢的肿瘤性骨病变。然而，它们具有侵袭性的局部生长和高复发率，导致 5 年总生存率为 65%，10 年总生存率为 35%。我们进行了一项荟萃分析和荟萃分析，比较了接受显微手术（MA）或内镜手术（EA）的患者的复发率、术后并发症和生存率。文献检索按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行，以确定 1990 年 1 月至 2018 年 3 月在 Pubmed、Scopus 和 Cochrane 上发表的斜坡脊索瘤手术系列。进行了两种不同的统计分析：总体复发率的汇总分析和单臂荟萃分析，以及开放手术和内镜手术亚组的并发症亚组荟萃分析。经过全文筛选，共有 58 篇文章纳入汇总分析，27 项研究纳入研究水平荟萃分析。汇总分析-切除程度是唯一仍然具有统计学意义的关联（亚组：HR = 2.18，p = 0.004；部分：HR = 4.40，p < 0.001）。与内镜手术患者（23.7%）相比，手术患者的复发率更高（45.5%）。荟萃分析-累积荟萃分析的结果显示，总体复发率为 25.6%。MA 的复发率为 31.8%（99%CI 14-52.8），EA 的复发率为 19.4%（5.4-39.2）。内镜组的脑脊液漏发生率为 10.3%（99%CI 5-17.3），开放手术组为 9.5%（99%CI 1.2-24.6）。部分切除与完全切除对复发率有影响（p < 0.001）。MA 的复发率为 31.8%；EA 的复发率为 19.4%。荟萃分析证实，与总体分析和荟萃分析一样，切除程度是影响复发风险的统计学显著因素。荟萃分析表明，老年患者比年轻患者更容易复发，尤其是在手术组。
