Department of Neurosurgery, Swedish Medical Center, Seattle, Washington, USA.
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
World Neurosurg. 2021 May;149:e316-e328. doi: 10.1016/j.wneu.2021.02.030. Epub 2021 Feb 16.
Spinal chondrosarcomas are rare primary malignant neoplasms composed of cartilage-producing cells. They are slow-growing but locally aggressive lesions that have high rates of recurrence and progression after treatment. We provide the largest comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chondrosarcoma using a large, prospectively collected national database.
Patients with diagnosis codes specific for chondrosarcoma of the spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization.
A total of 1843 individuals were identified with a diagnosis of chondrosarcoma, 82.1% of which were at the sacrum or coccyx and 17.9% at the spine. The mean overall survival of patients in our cohort was 7.91 years. Increased age, larger tumor, dedifferentiated histology, and presence of metastases were associated with worsened overall survival. Regarding management, 77.7% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, among patients who received radiation, those who received higher-dose radiation had significantly improved overall survival compared with those who received lower-dose radiation.
Surgical resection significantly improves overall survival in patients with spinal chondrosarcoma. In those patients receiving radiation, those who receive high doses have improved overall survival compared with those who receive lower doses. Further studies into optimal radiation modality and doses are required.
脊柱软骨肉瘤是由产生软骨的细胞组成的罕见原发性恶性肿瘤。它们生长缓慢，但局部侵袭性强，治疗后复发和进展率高。我们利用大型前瞻性国家数据库，对脊柱软骨肉瘤患者的预后因素、治疗方式和生存结果进行了最大规模的综合分析。
从 2004 年至 2016 年，国家癌症数据库（NCDB）中查询了脊柱、骶骨和尾骨软骨肉瘤的诊断代码。使用 Cox 单变量和多变量回归分析调查了结果，并生成了生存曲线进行比较可视化。
共确定了 1843 例诊断为软骨肉瘤的患者，其中 82.1%的患者位于骶骨或尾骨，17.9%的患者位于脊柱。我们队列中患者的总生存率平均为 7.91 年。年龄增加、肿瘤较大、去分化组织学和存在转移与总体生存率下降相关。在治疗方面，77.7%的患者接受了手术干预，部分和根治性切除均与显著改善的总体生存率相关（P<0.001）。放疗和化疗的应用均未改善总体生存率；然而，在接受放疗的患者中，接受高剂量放疗的患者的总体生存率明显高于接受低剂量放疗的患者。
手术切除可显著改善脊柱软骨肉瘤患者的总体生存率。在接受放疗的患者中，接受高剂量放疗的患者的总体生存率高于接受低剂量放疗的患者。需要进一步研究最佳放疗方式和剂量。
