颈椎脊索瘤无复发生存率的影响因素及预测模型

Prognostic factors and nomogram to predict the relapse-free survival of cervical chordoma

目的探讨影响颈椎脊索瘤患者无复发生存率的危险因素,并建立预测列线图模型。方法回顾性分析自1994年11月至2018年6月手术治疗的48例颈椎脊索瘤患者资料,其中男28例,女20例;年龄(48.5±15.4)岁(范围5~70岁)。统计所有患者年龄、性别、卡氏功能状态评分(Karnofsky performance status scale,KPS)、术前病程、病灶位置、累及节段、术前Frankel分级、组织学诊断方法、围手术期辅助放疗、手术切除方式及围手术期并发症等信息。术后3、6、12个月及之后每年规律随访患者病情变化及生存情况。应用Kaplan-Meier法及Log Rank检验进行单因素分析颈椎脊索瘤患者术后无复发生存率的影响因素;采用Cox回归分析进行多因素分析影响患者术后无复发生存率的独立因素;采用R软件构建列线图,计算Harrell’s concordance指数(c-index)评估模型区分能力。结果48例均获得随访,随访时间(66.6±51.1)个月(范围14~228个月)。至末次随访,48例中35例复发,1年无复发生存率为70.8%,3年无复发生存率42.1%,5年无复发生存率为30.9%。单因素分析结果示组织学诊断方法(P=0.016)、围手术期辅助放疗(P=0.027)和手术切除方式(P<0.001)是颈椎脊索瘤术后无复发生存率的影响因素,多因素分析结果显示手术切除方式(包膜外游离后经瘤切除或经瘤分块切除)[HR=0.209,95%CI(0.076,0.575)]是影响患者术后无复发生存率的独立因素。基于患者年龄、性别、病灶位置、累及节段、组织学诊断方法、围手术期辅助放疗和手术切除方式等因素建立预测患者术后1年、3年及5年无复发生存率列线图模型,c指数为0.760。结论穿刺活检、包膜外游离后经瘤切除术和接受辅助放疗可提高颈椎脊索瘤患者术后无复发生存率;建立的列线图模型可较准确地预测患者术后1、3、5年无复发生存率,为颈椎脊索瘤患者预后预测提供帮助。

Objective To explore the relevant prognostic factors and construct a nomogram to predict the relapse-free survival of cervical chordoma.Methods Data of 48 patients with cervical chordoma treated by operation from November 1994 to June 2018 were retrospectively analyzed,including 28 males and 20 females,aged 48.5±15.4 years(range 5-70 years).Data extraction comprised patients age,gender,Karnofsky performance status scale(KPS),duration of preoperative symptoms,location,involved segments,preoperative Frankel score,diagnostic biopsy method,adjuvant radiotherapy,surgical option and complications.Follow-up was conducted at 3,6,12 months after surgery and annually,X-Ray/CT/MRI were used to evaluate the progress of disease.Univariate analysis was performed using Kaplan-Meier survival analysis and Log Rank test to identify prognostic factors relevant to relapse-free survival,and multivariate Cox regression analysis was used in multivariate analysis,then R 3.6.2 was used to construct a nomogram.Results Mean follow-up time was 66.6±51.1 months(range 14-228 months),35 cases relapsed up to follow-up time,the cumulative 1-year,3-year and 5-year relapse-free survival were 70.8%,42.1%and 30.9%.Univariate analysis showed that diagnostic biopsy method(P=0.016),adjuvant radiation therapy(P=0.027),surgical option(P<0.001)were relevant to relapse-free survival of cervical chordoma.Multivariate Cox regression analysis showed that surgical option(intralesional resection after extracapsular separation vs.directly intralesional resection),HR=0.209,95%CI(0.076,0.575)had significant impacts on relapse-free survival of cervical chordoma.A nomogram with c-index of 0.760 to predict 1-year,3-year and 5-year relapse-free survival was conducted basing on age,gender,location,involved segments,diagnostic biopsy method,adjuvant radiation therapy,surgical option.Conclusion Aspiration biopsy,intralesional resection after extracapsular separation and adjuvant radiation therapy could prolong the relapse-free survival of cervical chordoma.The nomogram in this study could predict 1-year,3-year and 5-year relapse-free survival of cervical chordoma with relatively good accuracy.