Zuckerman Scott L, Lee Sun-Ho, Chang George J, Walsh Garrett L, Mehran Reza J, Gokaslan Ziya L, Rao Ganesh, Tatsui Claudio E, Rhines Laurence D
Department of Neurological Surgery, 12328Vanderbilt University School of Medicine, Nashville, TN, USA.
Department of Neurological Surgery, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Global Spine J. 2021 Jun;11(5):740-750. doi: 10.1177/21925682211011444.
Retrospective case series.
To determine predictive factors of overall survival (OS) and local recurrence (LR), report complications, and assess the impact of complications on survival, recurrence, and function in patients undergoing en bloc resection of sacral chordoma.
This retrospective case series was obtained from a prospective database (1995-2016). All patients underwent en bloc resection of sacral chordoma. Demographic, perioperative, and complication data were collected. Outcomes included: overall survival(OS), local recurrence(LR), and complications. Survival analysis with multivariable cox regression was performed.
Among 50 patients, median follow-up was 5.3 years (range = 1.3-17.2). The majority (82%) underwent a negative margin resection. 17 patients died (34%) with a median OS of 10.0 years (range = 1.3-17.2). Multivariable cox regression revealed that a negative margin resection was not significantly associated with improved survival (HR = 3.35, 95%CI 0.87-12.80, = .078). 20 patients (40%) experienced LR with a median time of 6.2 years (range = 0-16.9). Multivariable cox regression revealed that a negative margin resection was associated with a significant decreased risk of LR (HR = 4.96, 95%CI 1.84-13.34, = 0.002,). A 62% overall complication rate was seen (42% major), with 26% reoperation rate. Of the reoperations, 54% were delayed (>6 weeks after the index surgery). Multivariable cox regression demonstrated that neither major complication nor reoperation significantly impacted OS (HR = 0.62, 95%CI 0.22-1.79, = 0.380), LR (HR = 1.28, 95%CI 0.49-3.36, = 0.611), or functional outcomes (OR = 2.94, 95%CI 0.25-34.8, = 0.393).
Negative margin resection was associated with decreased LR. Neither major complication nor reoperation significantly impacted OS, LR, or functional outcome. Though additional studies are needed, it appears that despite the morbidity associated with sacral chordoma resection, the long-term clinical outcomes are favorable.
回顾性病例系列。
确定整体生存（OS）和局部复发（LR）的预测因素，报告并发症，并评估并发症对接受骶骨脊索瘤整块切除患者的生存、复发及功能的影响。
该回顾性病例系列取自一个前瞻性数据库（1995 - 2016年）。所有患者均接受了骶骨脊索瘤整块切除术。收集了人口统计学、围手术期及并发症数据。结局指标包括：整体生存（OS）、局部复发（LR）和并发症。进行了多变量Cox回归生存分析。
50例患者中，中位随访时间为5.3年（范围 = 1.3 - 17.2年）。大多数（82%）患者进行了切缘阴性切除术。17例患者死亡（34%），中位OS为10.0年（范围 = 1.3 - 17.2年）。多变量Cox回归显示，切缘阴性切除术与生存率提高无显著相关性（HR = 3.35，95%CI 0.87 - 12.80，P = 0.078）。20例患者（40%）出现LR，中位时间为6.2年（范围 = 0 - 16.9年）。多变量Cox回归显示，切缘阴性切除术与LR风险显著降低相关（HR = 4.96，95%CI 1.84 - 13.34，P = 0.002）。总体并发症发生率为62%（42%为严重并发症），再次手术率为26%。在再次手术中，54%为延迟手术（初次手术后>6周）。多变量Cox回归表明，严重并发症和再次手术均未对OS（HR = 0.62，95%CI 0.22 - 1.79，P = 0.380）、LR（HR = 1.28，95%CI 0.49 - 3.36，P = 0.611）或功能结局（OR = 2.94，95%CI 0.25 - 34.8）产生显著影响。
切缘阴性切除术与LR降低相关。严重并发症和再次手术均未对OS、LR或功能结局产生显著影响。尽管需要更多研究，但似乎尽管骶骨脊索瘤切除存在相关发病率，但其长期临床结局良好。
