Yu Y Y, Zang J, Wei R, Yang R L, Guo W, Tang X D
Musculoskeletal Tumor Center, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2024 Sep 1;62(9):878-884. doi: 10.3760/cma.j.cn112139-20230822-00054.
To investigate the survival and tumor recurrence after en bloc spondylectomy of spinal tumor and analyze the risk factors of postoperative tumor recurrence. This is a retrospective case series study. Data of 101 patients undergoing en bloc spondylectomy of spinal tumors in the Musculoskeletal Tumor Center, Peking University People's Hospital from December 2006 to June 2022 were analyzed. There were 58 males and 43 females, aged (38.2±15.8) years (range: 10 to 79 years) at the time of surgery; the follow-up time was(44.0±36.0) months (range: 12 to 171 months).Among them, there were 25 relapsed patients, with 7 females and 18 males; aged (34.8±16.3) years (range: 12 to 66 years) at the time of surgery. The types of tumors included 5 giant cell tumors of bone, 6 osteosarcomas, 1 chordoma, 5 chondrosarcomas, 1 undifferentiated sarcoma, 1 fibrosarcoma, 2 Ewing sarcomas, 3 metastases and 1 malignant giant cell tumor of bone. Survival analysis of overall and relapsed patients were performed using the Kaplan-Meier curves. A segmented regression model was used to fit the sequence of recurrence rate changes over time since admission and identify change points for further analysis on risk factors. Univariate and multivariate Logistic regression analysis were performed to assess risk factors associated with recurrence rate; results from multivariate regression analysis were presented using a forest plot. The tumor recurrence rate after en bloc spondylectomy was 24.8% (25/101).The overall median recurrence-free survival after en bloc spondylectomy was 161 months (95%: 92 months to NA).The median recurrence-free survival of recurrent patients was 13 months (95%: 12 to 27 months).Regarding the classification based on tumor malignancy, and relapse-free survival of metastatic tumors was significantly shorter (=0.007); and among the surgical margin groups, relapse-free survival of R0 group was significantly better than the R1 and R2 groups (<0.01). According to the segmented regression model, the tumor recurrence rate for en bloc spondylectomy showed a significant downward trend over time, with relatively higher recurrence rates before 2009 and a relatively stable trend after 2014. The results of univariate analysis showed that surgical margin and time of admission were the influencing factors of patient recurrence. The results of multivariate analysis showed that the R1 resection(=13.453,95%:2.897 to 97.941,=0.002) and R2 resection(=11.379,95%:2.658 to 79.429,=0.003) were independent influencing factor affecting patient recurrence. The overall tumor recurrence rate after en bloc spondylectomy was high. The surgical margin of tumor resection is an independent risk factor affecting tumor recurrence. Specifically, R2 and R1 resections significantly increase the risk of tumor recurrence.
探讨脊柱肿瘤整块切除术后的生存及肿瘤复发情况，并分析术后肿瘤复发的危险因素。这是一项回顾性病例系列研究。分析了2006年12月至2022年6月在北京大学人民医院肌肉骨骼肿瘤中心接受脊柱肿瘤整块切除术的101例患者的数据。其中男性58例，女性43例，手术时年龄为（38.2±15.8）岁（范围：10至79岁）；随访时间为（44.0±36.0）个月（范围：12至171个月）。其中，复发患者25例，女性7例，男性18例；手术时年龄为（34.8±16.3）岁（范围：12至66岁）。肿瘤类型包括5例骨巨细胞瘤、6例骨肉瘤、1例脊索瘤、5例软骨肉瘤、1例未分化肉瘤、1例纤维肉瘤、2例尤因肉瘤、3例转移瘤和1例骨恶性巨细胞瘤。采用Kaplan-Meier曲线对总体患者和复发患者进行生存分析。使用分段回归模型拟合自入院以来复发率随时间变化的序列，并确定变化点以进一步分析危险因素。进行单因素和多因素Logistic回归分析以评估与复发率相关的危险因素；多因素回归分析结果用森林图表示。脊柱肿瘤整块切除术后肿瘤复发率为24.8%（25/101）。脊柱肿瘤整块切除术后总体无复发生存期的中位数为161个月（95%：92个月至无上限）。复发患者的无复发生存期中位数为13个月（95%：12至27个月）。关于基于肿瘤恶性程度的分类，转移瘤的无复发生存期明显较短（P = 0.007）；在手术切缘组中，R0组的无复发生存期明显优于R1和R2组（P < 0.01）。根据分段回归模型，脊柱肿瘤整块切除术后的肿瘤复发率随时间呈显著下降趋势，2009年之前复发率相对较高，2014年之后呈相对稳定趋势。单因素分析结果显示，手术切缘和入院时间是患者复发的影响因素。多因素分析结果显示，R1切除（P = 13.453，95%：2.897至97.941，P = 0.002）和R2切除（P = 11.379，95%：2.658至79.429，P = 0.003）是影响患者复发的独立影响因素。脊柱肿瘤整块切除术后总体肿瘤复发率较高。肿瘤切除的手术切缘是影响肿瘤复发的独立危险因素。具体而言，R2和R1切除显著增加肿瘤复发风险。
