骶骨脊索瘤术后复发的相关因素分析

Analysis of recurrent factors of sacral chordoma

[目的]探讨影响骶骨脊索瘤患者术后复发的相关因素。[方法]对1993～2008年间完成初次手术的28例骶骨脊索瘤病例进行随访,将患者术后CDFS期作为应变量,选取患者发病年龄、性别、肿瘤大小、部位、初次手术方式、有无局部浸润以及术后是否放疗等因素作为自变量,采用Kaplan-Meier法,Log-Rank法进行分析。[结果]28例患者随访时间平均为(76.2±47.2)个月,最后随访时共复发13例(46.4%),首次复发时间平均为(35.9±27.2)个月。Kaplan-Meier法单因素变量分析显示肿瘤部位、手术方式、有无局部浸润是影响骶骨脊索瘤患者术后复发的独立预测因素(P<0.05)。患者年龄、性别、肿瘤大小、术后是否放疗与复发无明显关系(P>0.05)。[结论]肿瘤部位高、手术切除不彻底和术前发生局部浸润患者复发率较高,术后CDFS期较短。扩大切除术有利于降低术后的复发率,延长术后CDFS期,术前仔细评估MRI有助于选择合理的手术方案。

[ Objective ] To retrospectively investigate recurrent factors of sacral chordoma after surgical treatment. [ Methods] This retrospective study included 28 patients with sacral chordoma who underwent primary operation from 1993 to 2008. The data on gender, age, tumor size, tumor location, invasion of the surrounding muscle, surgical type, and radiation therapy were reviewed. Continuous disease - free survival time （CDFS） was calculated according to the Kaplan - Meier method and statistical analysis was performed by using Log - Rank test. [ Results ] The mean follow - up time was 76.2 months. At the final follow - up, 13 of 28 patients （46.4%） developed local recurrences, and the average recurrence time was 35.9 months. Kaplan - Meier single factor analysis displayed that tumor location, invasion of the surrounding muscle, and surrgical type were the risk of the recurrence of sacral chordoma after surgical treatment （P 〈 0. 05） . CDFS had no significant difference between different age groups, sex groups, tumor size groups, and radiation therapies （ P 〉 0. 05 ） . [ Conclusion ] The higher level of tumor involvement, incomplete excision, and invasion into the surrounding muscles will probably lead to shorter CDFS. Tumor resection with wide surgical margins may have a better prognosis for these patients. Careful preoperative evaluation may help to plan reasonable operation.