骶骨脊索瘤的临床特点及预后因素分析  

Clinical features and prognostic factors analysis of sacral chordoma

作　　者：周磊[1] 孟通[1] 杨兴海[1] 魏海峰[1] 严望军[1] 刘铁龙[1] 宋滇文[1] 肖建如[1] 

机构地区：[1]第二军医大学附属长征医院骨肿瘤科,上海200003

出　　处：《脊柱外科杂志》2015年第5期280-284,共5页Journal of Spinal Surgery

基　　金：上海市科委引导类科技项目(14411963700)

摘　　要：目的探讨骶骨脊索瘤的临床特点和影响手术预后的相关因素,从而判定影响骶骨脊索瘤的局部复发和总体生存的因素。方法回顾性分析1991年1月~2012年12月在本院行手术治疗的骶骨脊索瘤患者资料95例。应用单因素生存分析和多因素Cox比例风险模型判定独立危险因素。生存率通过Kaplan-Meier曲线计算,通过对数秩检验判定统计学差异。选择P≤0.1的影响因素进入多因素Cox比例风险模型,判定独立危险因素。结果本组病例平均随访29个月,其中33例患者术后局部复发,局部复发率为34.7%（33/95）;20例患者在本研究随访终止前死亡,总体生存率78.9%（75/95）,术后生存时间（78.8±4.7）个月。在各临床因素中,术前Frankel分级、Enneking分期及手术方式与局部复发密切相关;年龄、性别、术前Frankel分级、术前选择性肿瘤动脉栓塞术与患者死亡密切相关。结论外科手术可提高骶骨脊索瘤患者的生存质量,延长患者生存期。30~70岁的男性患者总体生存率较高,术前较好的Frankel分级、EnnekingⅠ期、全脊椎en-bloc切除术可明显降低骶骨脊索瘤复发率;Frankel分级可作为术后总体生存率的独立预后因素。Objective To investigate the clinical characteristics of sacral chordoma（ SC） and the prognostic factors of operation,so as to identify the factors affecting the local relapse and overall survival（ OS） of SC.Methods A retrospective analysis of patients with SC treated surgically between January 1991 and December 2012 was performed.The univariate survival analysis and multivariate Cox proportional hazards analysis were carried out to identify independent prognostic factors.OS rate was estimated by the Kaplan-Meier method,and differences were analyzed by the log-rank test.Factors with P≤0.1were subjected to multivariate analysis by Cox regression analysis.P ≤ 0.05 were considered statistically significant.Results A total of 95 patients with SC were included in the study.The mean follow-up period was 29 months.Local relapse was detected in 33 patients after initial surgery with the local relapse rate 34.7%（ 33 /95）,while death occurred in 20 cases with the OS rate 78.9%（ 75 /95）.In addition,the time of OS was 78.8 ± 4.7 months.The statistical analysis suggested that preoperative Frankel classification,Enneking staging and resection mode were independent prognostic factors for local relapse.In addition,age,gender,preoperative Frankel classification and preoperative selective arterial embolism（ PSAE） was related to the death of the patients.Conclusion Surgery is the ideal treatment for SC.It can not only improve the quality of lives of patients,but also prolong survival.Preoperative Frankel classification（ D-E） 、Enneking stage Ⅰ and total en-bloc spondylectomy can significantly degrade local relapse rate.In addition,male patients between 30 and 70 years old have a favorable OS rate,and preoperative Frankel classification is also an independent prognostic factor for OS rate.

关 键 词：骶骨 脊索瘤 肿瘤复发 局部 存活率分析 预后 

分 类 号：R738.1[医药卫生—肿瘤]