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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S_(1～5)7例,S_(2～5)15例,S_(3～5)33例,S_(4～5)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。
Objective To review the results of long-term follow-up after surgical treatment of sacral chordoma and to analyze and evaluate the clinical factors influencing the effect of surgical treatment. Methods From October 1978 to October 2000, 68 patients with sacral chordoma were treated in our hospital. There were 60 males and 8 females, aged from 25 to 74 years, with a median age of 55.5 years and sites of S_ (1 ~ 5) 7 Cases, S_ (2 ~ 5) in 15 cases, S_ (3 ~ 5) in 33 cases, S_ (4 ~ 5) in 5 cases, the other 8 cases. A total of 104 cases of surgical operations, the first surgical treatment in our hospital 48 cases of primary cases, surgical excision of the border for extensive excision in 4 cases (8.3%); marginal resection in 21 cases (43.7%); cystotomy in 23 cases (48.0 %); Recurrence in 20 cases. The results were followed up for 1-365 months, an average of 81.84 months. Survival in 53 cases (77.9%); 15 cases died (22.1%), of which 7 cases were perioperative deaths, accounting for 46.7% of the total deaths. The overall 5-year survival rate was 87.3%, the 10-year survival rate was 73.3%, and the median survival time (month) was 282.0 ± 88.7. Among them, the 5-year survival rates of the patients who underwent resection, marginal resection and extensive resection did not differ significantly (P = 0.18). There were 34 (81.0%) cases of recurrence after surgical resection and 8 (36.4%) cases of marginal resection with statistical difference (P = 0.000). The overall 1-year recurrence-free survival rate was 77.4% Year 24.3%. There was a statistically significant difference in the relapse-free survival between the first surgery and the first surgery in our hospital (log-rank P = 0.000). There was a statistically significant difference in recurrence-free survival between marginal resection and cyst excision (log-rank P = 0.000). Cox regression analysis showed that the first surgery and different surgical boundaries in our hospital were independent predictors of local recurrence. Conclusions Sacral chordoma is surgically removed with high local recurrence rate and long survival period. Surgical excision boundary is an important factor affecting local recurrence. The first operation has an important effect on prognosis.