骶骨脊索瘤外科治疗长期随访

目的 回顾骶骨脊索瘤外科治疗后长期随访的结果,分析评估影响外科治疗效果的临床因素.方法 1978年10月至2000年10月,我院共收治68例骶骨脊索瘤,男性60例,女性8例,年龄25～74岁,中位年龄55.5岁,部位为S1～5 7例,S2～5 15例,S3～5 33例,S4～5 5例,其他8例.外科手术共104例次,首次在我院外科治疗的原发病例48例,肿瘤外科切除边界为广泛切除4例（8.3%）;边缘切除21例（43.7%）;囊内切除23例（48.0%）;复发病例20例.结果 随访1-365个月,平均81.84个月.存活53例（77.9%）;死亡15例（22.1%）,其中,围手术期内死亡7例,占死亡总数的46.7%.总体5年生存率87.3%,10年生存率73.3%,中位生存时间（月）282.0±88.7.其中囊内切除者、边缘切除者和广泛切除者5年生存率,三者比较统计学无明显差异（P=0.18）.手术囊内切除者复发34例（81.0%）,边缘切除者复发8例（36.4%）,统计学差异明显（P=0.000）;总体1年无复发生存率77.4%;3年33.2%,5年24.3%.我院首次手术与非我院首次手术患者的无复发生存率比较,统计学差异明显（log-rank P=0.000）.边缘切除与囊内切除患者的无复发生存率比较,统计学差异明显（log-rank P=0.000）.Cox回归分析显示是否我院首次手术及不同手术边界均为预测局部复发的独立因素.结论 骶骨脊索瘤外科切除,局部复发率高,生存期较长,外科切除边界是影响局部复发的重要因素,首次手术对于预后有重要影响.

The long-term follow-up of the surgical treatment of sacral chordoma

Objective To review the results of the long-term follow-up of sacral chordoma after the surgical resection and evaluate clinical factors which influence the effect of the surgical treatment. Methods From October 1978 to October 2000, 68 patients with sacral chordoma were treated in our institution, with 60 males and 8 females. Their mean age was 55.5 years （range; 25-74 years）. As for locations, 7 cases were at $1.5, 15 cases at S24, 33 cases at S34. 5 cases at S44 and 8 cases at other locations. Patients received 104 times of surgeries altogether among whom 48 patients had primary treatment at the time of diagnosis in our institution. We evaluated the surgical margins of these 48 patients and found out 4 wide margins （8.3%）, 21 marginal margins （43.7%） and 23 intralesional margins （48.0%）. 20 patients had local recurrence. Results The mean follow-up period was 81.84 months （range; 1-365 months）. 53 patients survived （77.9%） and 15 patients died （22.1%）, and among whom 7 patients died in the perioperative period （46.7%）. Overall survival rate was 87.3% at 5 years and 73.3% at 10 years with the median survival period 282.0±88.7 months. We found no statistical significance in the 5-year survival rate in the patients＇ resections with intralesional, marginal and wide surgical margins （log-rank P=0.18）. 34 patients with intralesional surgical margins had local recurrence （81.0%） and 8 patients with marginal surgical margins had local recurrence （36.4%） with significant statistical differences （P=0.000）. Survival rate to local recurrence was 77.4% at 1 years, 33.2% at 3 years and 24.3% at 5 years. There were statistical differences in the survival rate to the local recurrence between patients who had primary treatment in our institution or not （log-rank P=0.000）. The same results could be found between patients with marginal resection and intralesional resection （log-rank P=0.000）. Cox regression analysis showed that whether patients had primary treatment in our institution or not and different surgical margins were independent predictors to the local recurrence. Conclusions The surgical resection of sacral chordoma has the features of high risk of local recurrence and comparatively long surviving period. Surgical resection margins of sacral chordoma is an important factor that affects the risk of local recurrence. The primary surgical treatment has significant influence on the prognosis.