Pham John, Shaaya Elias, Rhee Ben, Kimata Anna, Ozcan Evrim E, Pham Katie M, Niu Tianyi, Sullivan Patricia, Gokaslan Ziya L
Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
Front Oncol. 2024 Jan 30;13:1327330. doi: 10.3389/fonc.2023.1327330. eCollection 2023.
The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups.
The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality.
There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762).
GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.
在老年人群中，积极手术切除与成人脊索瘤患者生存率提高之间的关联尚未得到充分描述。因此，本研究旨在阐明不同年龄组患者的全切除（GTR）与生存结果之间的关系。
作者从2000 - 2019年监测、流行病学和最终结果数据库中筛选出所有诊断为脊索瘤的成年患者，并将患者分为三个手术亚组：未手术、次全切除（STR）和GTR。采用Kaplan - Meier曲线和对数秩检验来辨别手术亚组之间总生存期（OS）的差异。单因素和多因素分析用于确定死亡的预后因素。
共有771例符合条件的患者：227例（29.4%）未接受手术，267例（34.6%）接受了STR，277例（35.9%）接受了GTR。未接受手术的患者5年总生存率（45.2%）、10年总生存率（17.6%）和平均总生存期（72.1个月）最低。按年龄对患者进行分层后，我们的多因素分析表明，40 - 59岁（HR = 0.26，CI = 0.12 - 0.55，p < 0.001）、60 - 79岁（HR = 0.51，CI = 0.32 - 0.82，p = 0.005）和80 - 99岁（HR = 0.14，CI = 0.05 - 0.37，p < 0.001）接受GTR的患者与未接受手术的患者相比，死亡风险较低。接受GTR的频率也随着年龄的增长而降低（80 - 99岁为16.4%，20 - 39岁为43.2%；p < 0.001），但各年龄组接受放疗的频率相当（80 - 99岁为48.3%，20 - 39岁为45.5%；p = 0.762）。
GTR与中老年脊索瘤患者生存率的提高相关。因此，不应仅凭年龄就将患者排除在积极手术切除之外。相反，是否进行手术应根据个体情况决定。
