Patel Saavan, Nunna Ravi S, Nie James, Ansari Darius, Chaudhry Nauman S, Mehta Ankit I
Department of Neurosurgery, 14681University of Illinois at Chicago, IL, USA.
Global Spine J. 2023 Mar;13(2):334-343. doi: 10.1177/2192568221995155. Epub 2021 Feb 15.
Retrospective cohort study.
Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma.
Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization.
1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival ( < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation.
Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required.
回顾性队列研究。
脊索瘤是原始脊索罕见的原发性恶性肿瘤。它们生长缓慢，但具有局部侵袭性，治疗后复发和转移率高。金标准治疗仍然是整块手术切除，而放疗和化疗等辅助治疗的疗效存疑。在此，我们对脊索瘤患者的预后因素、治疗方式和生存结果进行了全面分析。
从2004年至2016年期间的国家癌症数据库（NCDB）中查询诊断编码特定为脊柱、骶骨和尾骨脊索瘤的患者。使用Cox单因素和多因素回归分析研究结果，并生成生存曲线以进行比较可视化。
共识别出1548例诊断为脊索瘤的患者，其中60.9%位于骶骨或尾骨，39.1%位于脊柱。我们队列中患者的平均总生存期为8.2年。年龄增加、肿瘤体积增大和存在转移与总生存期恶化相关。71.2%的患者接受了手术干预，部分切除和根治性切除均与总生存期显著改善相关（<0.001）。放疗和化疗均未改善总生存期；然而，在接受放疗的患者中，接受质子放疗的患者与传统放疗相比总生存期显著改善。
手术切除显著改善了脊索瘤患者的总生存期。在接受放疗的患者中，接受质子治疗方式的患者总生存期得到改善。需要对质子放疗剂量进行进一步研究。
