21例骶尾部脊索瘤临床分析

Clinical Analysis of 21 Patients with Sacrococcygeal Chordoma

目的:探讨骶尾部脊索瘤的临床特点及治疗方法。方法:回顾性分析天津医科大学附属肿瘤医院1989年1月至2004年12月收治的21例骶尾部脊索瘤患者的临床资料,11例接受单纯手术治疗,10例接受手术+术后放疗,放射治疗剂量为40～50Gy。结果:9例患者死亡,6例死于局部复发,1例死于双肺转移,2例死于非肿瘤相关疾病。全组1、3、5、10年生存率分别为100%、95%、85%、41%。单纯手术组的5年生存率为81%,手术+术后放疗组的5年生存率为89%,二者无显著性差异(P=0.256>0.05)。局部复发15例,单纯手术组9例,局部复发率为81.8%,手术+放疗组6例,局部复发率为60%,二者无显著性差异(χ2=1.222,P=0.269>0.05)。单纯手术组局部复发时间为术后2个月～38个月,中位复发时间22个月;手术+放疗组发生复发时间为术后23个月～个72月,中位复发时间48个月。结论:脊索瘤极易复发,患者就诊状态及治疗手段可能为影响复发的因素,手术切除为其主要治疗手段,术后辅以放疗未能明显提高生存率及减少局部复发,但推迟了局部复发时间。

Objective： To evaluate the clinical characteristics of sacrococcygeal chordoma and its treatment. Methods： The data from 21 patients （13 males and 8 females, with an average age of 58.8 years） with sacrococcygeal chordoma treated in our hospital from January 1989 to December 2004 were retrospectively reviewed. The mean diameter of the tumor was 9.5 cm, ranging from 4 to 25 cm. All of the patients underwent surgery. Three cases had radical surgery and 18 cases had partial excision. Eleven patients received surgery alone （S） and the other 10 patients were treated with surgery plus postoperative radiotherapy （S＋R）. The daily dose of radiotherapy was 180-200 cGy for five fractions a week and the total dose was 40-50 Gy delivered over 4-5 weeks. Results： In the follow-up period, 9 deaths occurred. Six cases died from local recurrence, 1 case died from bilateral lung metastasis and the other cases died from unrelated diseases. The overall 1-, 3-, 5- and 10-year survival rates were 100%, 95%, 85% and 41%, respectively. The 5-year survival rate was 81% in the S group and 89% in the S＋R group, with no statistical significance between the 2 groups （P〉0.05）. Local recurrence occurred in 15 cases （9 in the S group and 6 in the S＋R group）. The recurrence rate was 81.8% in the S group and 60% in the S＋R group, with no significant difference （x^2=1.222,P〉0.05）. The local recurrence time was 2-38 months after surgery in the S group and 23-72 months in the S＋R group. The median recurrence time was 22 months in the S group and 48 months in the S＋R group. Conclusion： Recurrence frequently occurred in patients with chordoma. Treatment methods affect recurrence. Radical resection is the most efficient treatment for sacrococcygeal chordoma. Postoperative radiotherapy does not remarkably increase survival or reduce the incidence of local recurrence, but it can delay the recurrence time.