神经内镜经颅底腹侧入路治疗儿童颅底脊索瘤的疗效及生存分析  

Efficacy and survival analysis of endoscopic skull base ventral resection of skull base chordomas in children

作　　者：白吉伟[1] 郑仕奇 李明轩[2] 张熙佳 李储忠 赵澎[1] 曹磊[1] 刘春晖[1] 刘幸[2] 桂松柏 张亚卓[2] Bai Jiwei;Zheng Shiqi;Li Mingxuan;Zhang Xijia;Li Chuzhong;Zhao Peng;Cao Lei;Liu Chunhui;Liu Xing;Gui Songbai;Zhang Yazhuo(Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101149,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科学中心,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070 [3]首都医科大学附属北京潞河医院神经外科,北京101149

出　　处：《中华神经外科杂志》2023年第12期1202-1209,共8页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(82272939)。

摘　　要：目的观察神经内镜经颅底腹侧入路治疗儿童颅底脊索瘤的疗效,分析影响患儿生存率的相关因素。方法回顾性分析2007年12月至2022年12月首都医科大学附属北京天坛医院神经外科学中心采用神经内镜经颅底腹侧入路治疗的70例颅底脊索瘤患儿的临床资料。其中2007—2019年的33例为早期手术组,2020—2022年的37例为近期手术组。近期手术组采用"龟背"形顺序探查及切除肿瘤的手术策略。观察患儿的肿瘤切除程度及其影响因素。随访患儿的无进展生存期(PFS)和总生存期(OS),绘制Kaplan-Meier生存曲线,采用log-rank检验比较不同疾病特征的传统型脊索瘤患儿生存率的差异;将差异有统计学意义的指标纳入多因素Cox回归模型,分析影响生存率的相关因素。结果70例患儿共行80例次手术。早期手术组中,肿瘤全切除者占23.7%(9/38),近期手术组中占54.8%(23/42);肿瘤体积<20 cm3、20~80 cm3、>80 cm3的患儿中,肿瘤全切除者分别占63.3%(19/30)、26.8%(11/41)、2/9;原发与复发肿瘤的患儿中,肿瘤全切除者分别占51.9%(27/52)、17.9%(5/28)。上述指标比较,肿瘤全切除率的差异均有统计学意义(均P<0.05)。而肿瘤位置、手术入路不同者肿瘤全切除率的差异均无统计学意义(均P>0.05)。术后病理学证实,脊索瘤为传统型63例、差分化型5例、去分化型和肉瘤样型各1例(后3者定义为其他亚型)。术后70例患儿的中位随访时间为31个月(2~173个月)。随访期内,死亡11例(15.7%),存活59例(84.3%),肿瘤全切除的患儿无一例死亡。Kaplan-Meier生存分析显示,63例传统型脊索瘤患儿1、2、5年的生存率分别为95.0%、95.0%和89.8%,7例其他亚型患儿1、2年的生存率为57.1%和21.4%。log-rank检验分析63例传统型脊索瘤患儿的结果显示,肿瘤体积越大、切除程度越小的患儿OS越短(均P<0.05);性别、原发或复发肿瘤、肿瘤位置、是否行放疗对OS的影响不大(均P>0.05)�Objective To explore the efficacy,survival outcome,and prognostic factors of endoscopic skull base ventral resection of skull base chordomas in children.Methods A retrospective analysis was conducted on the clinical data of 70 children with skull base chordomas who underwent endoscopic skull base ventral resection at the Neurosurgery Center,Beijing Tiantan Hospital,Capital Medical University from December 2007 to December 2022.Among them,33 cases from 2007 to 2019 were in the early surgery group and 37 cases in 2020-2022 were in the recent surgery group.Recently,the surgical team adopted a"turtle-back-shaped"surgical strategy of sequential exploration and tumor resection.We then investigated the extent of tumor resection and its influencing factors in children.The progression-free survival(PFS)and overall survival(OS)of the children were followed up.Kaplan-Meier survival analysis was performed to compare the differences in the survival among children with different disease characteristics.Indicators with statistically significant differences were incorporated into the multivariate Cox regression model to analyze the related factors affecting the patients′survival.Results A total of 80 operations were performed on 70 children.Among those who underwent early surgery,total tumor resection accounted for 23.7%(9/38)and among those who underwent recent surgery accounted for 54.8%(23/42).Among children with tumor volume<20 cm3,20-80 cm3,and>80 cm3,total tumor resection accounted for 63.3%(19/30),26.8%(11/41),and 2/9 respectively.Among children with primary and recurrent tumors,total tumor resection accounted for 51.9%(27/52)and 17.9%(5/28)respectively.The differences in the above indicators were all statistically significant(all P<0.05).However,there was no statistically significant difference in the total tumor resection rate between patients with different tumor locations and surgical approaches(all P>0.05).Postoperative pathology confirmed that 63 cases of chordoma were conventional type,5 cases were poorly differe

关 键 词：脊索瘤 颅底 儿童 自然腔道内镜手术 预后 影响因素分析 

分 类 号：R739.4[医药卫生—肿瘤]