原发骶骨脊索瘤外科治疗后复发的因素分析
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摘要
目的分析原发骶骨脊索瘤外科治疗后复发的危险因素。方法收集本院1982年1月至2013年12月收治的初治原发骶骨脊索瘤患者126例,手术入路分为前后联合和单纯后路两种,根据肌肉骨骼系统肿瘤外科(Enneking)分期评价外科边界为囊内切除48例、边缘切除52例和广泛切除26例。术后进行随访并分析术后复发情况及可能影响复发的危险因素。结果术后随访12～279个月,中位随访47.5个月,随访期内复发28例(22.2%)。25例复发患者再次接受手术治疗,其中10例术后再次复发(复发时间范围3～97个月,中位38.5个月)。28例复发患者中术后2、3和5年内复发分别有11例(39.3%)、16例(57.1%)和26例(92.9%)。Kaplan-Meier生存分析显示3、5年的无复发生存率分别为86.7%和67.5%。单因素分析显示男性复发率为24.5%(26/106),高于女性的10.0%(2/20),差异有统计学意义(P=0.001);累及S_3以上的复发率为32.4%(12/37),高于累及S_3以下的8.0%(16/89),差异有统计学意义(P=0.001);囊内、边缘与广泛切除的复发率分别为31.2%(15/48)、21.1%(11/52)和7.7%(2/26),差异有统计学意义(P=0.009)。多因素分析发现肿瘤位置(P=0.035)和外科边界(P=0.005)是影响复发的独立危险因素。结论骶骨脊索瘤术后复发率较高,尤其是S_3以上水平易复发,通过广泛切除达到安全外科边界是局部控制的关键。
Objective To analyze the risk factors of recurrence of primary sacral chordoma after surgical treatment. Methods One hundred and twenty-six cases of primary sacral chordoma initially treated in our hospital from January 1982 to December 2013 were collected. Surgical approach was divided into anterior-posterior combined approach and simple posterior approach. According to the Enneking stage of musculoskeletal system tumors, 48 cases had intracapsular resection, 52 cases had marginal resection and 26 cases had extensive resection. Postoperative follow-up was carried out and recurrence and possible risk factors for recurrence were analyzed.Results Postoperative follow-up ranged from 12 to 279 months with a median follow-up of 47.5 months. Twenty-eight cases(22.2%) relapsed during the follow-up period. Twenty-five patients with recurrence underwent reoperation, and 10 of them had recurrence after operation(recurrence time ranged from 3 to 97 months, median 38.5 months). Among 28 patients with recurrence, 11(39.3%), 16(57.1%) and 26(92.9%) had recurrence within 2, 3 and 5 years after operation. Kaplan-Meier survival analysis showed that the 3-and 5-year recurrence-free survival rates were 86.7% and 67.5%, respectively. Univariate analysis showed that the recurrence rate was 24.5%(26/106) in males, higher than 10.0%(2/20) in females(P=0.001); the recurrence rate above S_3 was 32.4%(12/37), higher than 8.0%(16/89) below S_3(P=0.001); the recurrence rates of intracapsular, marginal and extensive excisions were 31.2%(15/48), 21.1%(11/52) and 7.7%(2/26) with significant difference(P=0.009). Multivariate analysis showed that tumor location(P=0.035) and surgical margin(P=0.005) were independent risk factors for recurrence. Conclusion The recurrence rate of sacral chordoma is relatively high after operation, especially at the level above S_3, which is easy to recur. The key to local control is to reach the safe surgical boundary through extensive resection.
Objective To analyze the risk factors of recurrence of primary sacral chordoma after surgical treatment. Methods One hundred and twenty-six cases of primary sacral chordoma initially treated in our hospital from January 1982 to December 2013 were collected. Surgical approach was divided into anterior-posterior combined approach and simple posterior approach. According to the Enneking stage of musculoskeletal system tumors, 48 cases had intracapsular resection, 52 cases had marginal resection and 26 cases had extensive resection. Postoperative follow-up was carried out and recurrence and possible risk factors for recurrence were analyzed.Results Postoperative follow-up ranged from 12 to 279 months with a median follow-up of 47.5 months. Twenty-eight cases(22.2%) relapsed during the follow-up period. Twenty-five patients with recurrence underwent reoperation, and 10 of them had recurrence after operation(recurrence time ranged from 3 to 97 months, median 38.5 months). Among 28 patients with recurrence, 11(39.3%), 16(57.1%) and 26(92.9%) had recurrence within 2, 3 and 5 years after operation. Kaplan-Meier survival analysis showed that the 3-and 5-year recurrence-free survival rates were 86.7% and 67.5%, respectively. Univariate analysis showed that the recurrence rate was 24.5%(26/106) in males, higher than 10.0%(2/20) in females(P=0.001); the recurrence rate above S_3 was 32.4%(12/37), higher than 8.0%(16/89) below S_3(P=0.001); the recurrence rates of intracapsular, marginal and extensive excisions were 31.2%(15/48), 21.1%(11/52) and 7.7%(2/26) with significant difference(P=0.009). Multivariate analysis showed that tumor location(P=0.035) and surgical margin(P=0.005) were independent risk factors for recurrence. Conclusion The recurrence rate of sacral chordoma is relatively high after operation, especially at the level above S_3, which is easy to recur. The key to local control is to reach the safe surgical boundary through extensive resection.
引文
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[11] Kabolizadeh P,Chen YL,Liebsch N,et al.Updated outcome and analysis of tumor response in mobile spine and sacral chordoma treated with definitive high-dose photon/proton radiation therapy [J].Int J Radiat Oncol Biol Phys,2017,97(2):254-262.
[12] Pennicooke B,Laufer I,Sahgal A,et al.Safety and local control of radiation therapy for chordoma of the spine and sacrum:a systematic review [J].Spine (Phila Pa 1976),2016,41(Suppl 20):186-192.
[13] Jung EW,Jung DL,Balagamwala EH,et al.Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma [J].Technol Cancer Res Treat,2017,16(3):302-309.
[2] Yu E,Koffer PP,DiPetrillo TA,et al.Incidence,treatment,and survival patterns for sacral chordoma in the United States,1974-2011 [J].Front Oncol,2016,6:203.
[3] Baratti D,Gronchi A,Pennacchioli E,et al.Chordoma:natural history and results in 28 patients treated at a single institution [J].Ann Surg Oncol,2003,10(3):291-296.
[4] York JE,Kaczaraj A,Abi-Said D,et al.Sacral chordoma:40-year experience at a major cancer center [J].Neurosurgery,1999,44(1):74-79.
[5] Chen KW,Yang HL,Lu J,et al.Prognostic factors of sacral chordoma after surgical therapy:a study of 36 patients [J].Spinal Cord,2010,48(2):166-171.
[6] Fuchs B,Dickey ID,Yaszemski MJ,et al.Operative management of sacral chordoma [J].J Bone Joint Surg Am,2005,87(10):2211-2216.
[7] Yonemoto T,Tatezaki S,Takenouchi T,et al.The surgical management of sacrococcygeal chordoma [J].Cancer,1999,85(4):878-883.
[8] Radaelli S,Stacchiotti S,Ruggieri P,et al.Sacral chordoma:long-term outcome of a large series of patients surgically treated at two reference centers [J].Spine (Phila Pa 1976),2016,41(12):1049-1057.
[9] Xie C,Whalley N,Adasonla K,et al.Can local recurrence of a sacral chordoma be treated by further surgery?[J].Bone Joint J,2015,97(5):711-715.
[10] Thieblemont C,Biron P,Rocher F,et al.Prognostic factors in chordoma:role of postoperative radiotherapy [J].Eur J Cancer,1995,31(13-14):2255-2259.
[11] Kabolizadeh P,Chen YL,Liebsch N,et al.Updated outcome and analysis of tumor response in mobile spine and sacral chordoma treated with definitive high-dose photon/proton radiation therapy [J].Int J Radiat Oncol Biol Phys,2017,97(2):254-262.
[12] Pennicooke B,Laufer I,Sahgal A,et al.Safety and local control of radiation therapy for chordoma of the spine and sacrum:a systematic review [J].Spine (Phila Pa 1976),2016,41(Suppl 20):186-192.
[13] Jung EW,Jung DL,Balagamwala EH,et al.Single-fraction spine stereotactic body radiation therapy for the treatment of chordoma [J].Technol Cancer Res Treat,2017,16(3):302-309.