Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
J Surg Oncol. 2021 Apr;123(5):1284-1291. doi: 10.1002/jso.26423. Epub 2021 Feb 10.
Chordomas of the mobile spine (C1-L5) are rare malignant tumors. The purpose of this study was to review the outcome of surgical treatment for patients with primary mobile spine chordomas.
The oncologic outcomes and survival of 26 patients undergoing surgical resection for a primary mobile spine chordoma were assessed over a 25-year period. The mean follow-up was 12 ± 6 years.
The 2-, 5-, and 10-year disease-free survivals were 95%, 61%, and 55%. The local recurrence-free survival was improved in patients receiving en bloc resection with negative margins (83% vs. 35%, p = 0.02) and similar in patients receiving adjuvant radiation therapy (43% vs. 45%, p = 0.30) at 10 years. Debulking of the tumor (hazard ratio [HR] = 6.41, p = 0.01) and a local recurrence (HR = 9.52, p = 0.005) were associated with death due to disease. Complications occurred in 19 (73%) patients, leading to reoperation in 9 (35%) patients; this rate was similar in intralesional and en bloc procedures.
Surgical resection of mobile spine chordomas is associated with a high rate of complications; however, en bloc resection can provide a hope for cure and appears to confer better oncologic outcomes for these tumors without an increase in complications compared to lesser resections.
脊柱可移动部位（C1-L5）的脊索瘤是罕见的恶性肿瘤。本研究旨在回顾接受手术治疗的原发性脊柱可移动脊索瘤患者的治疗结果。
回顾性分析 25 年间 26 例接受手术切除原发性脊柱可移动脊索瘤患者的肿瘤学结果和生存情况。平均随访时间为 12±6 年。
2 年、5 年和 10 年无疾病生存率分别为 95%、61%和 55%。肿瘤切缘阴性的整块切除术（83%比 35%，p=0.02）和术后辅助放疗（43%比 45%，p=0.30）的局部无复发生存率在 10 年时均得到改善。肿瘤减灭术（危险比 [HR] =6.41，p=0.01）和局部复发（HR=9.52，p=0.005）与疾病相关的死亡有关。19 例（73%）患者发生并发症，导致 9 例（35%）患者再次手术；肿瘤整块切除术和肿瘤部分切除术的并发症发生率相似。
脊柱可移动脊索瘤的手术切除与高并发症发生率相关；然而，整块切除术可为治愈提供希望，与较小范围的切除术相比，似乎不会增加并发症，还能为这些肿瘤提供更好的肿瘤学结果。
