Abstract：
OBJECTIVE: Spinal chordoma treatment guidelines recommend resection. However, in patients in whom gross-total resection (GTR) is achieved, the benefits of radiation therapy (RT) are unclear. Therefore, the authors performed a systematic review to determine if RT is associated with postoperative progression-free survival (PFS) or overall survival (OS) after achieving GTR of spinal chordoma.
METHODS: The PubMed database was searched for studies including individualized data of patients undergoing GTR with or without RT for spinal chordoma. Patients < 18 years of age or those who underwent stereotactic body RT were excluded. Qualitative assessment was performed using Newcastle-Ottawa Scale guidelines. Log-rank tests for time-to-event data and a Cox proportional-hazards model were generated for a multivariable statistical model.
RESULTS: Complete data of 132 patients were retrieved, with 37 (28%) patients receiving adjuvant RT and 95 (72%) not receiving adjuvant RT. The mean follow-up was not statistically significantly different between those undergoing RT and not undergoing RT (54.02 months and 65.43 months, respectively). Patients were more likely not to undergo RT if their disease was located in the sacrum versus the mobile spine (p < 0.001). When controlling for age ≥ 65 years, male sex, disease location, and treatment year ≥ 2010, patients undergoing RT had similar PFS and OS when compared with those not undergoing RT on multivariable survival analysis (HR 0.935 [95% CI 0.703-2.340], p = 0.844 and HR 2.078 [95% CI 0.848-5.090], p = 0.110, respectively). However, age ≥ 65 years was associated with poorer OS in adjusted analyses (HR 2.761 [95% CI 1.185-6.432], p = 0.018) relative to patients < 65 years of age.
CONCLUSIONS: After achieving GTR of spinal chordoma, the utility of RT on PFS and OS remains unclear. Age ≥ 65 years appears to be associated with OS in spinal chordoma patients. Additional multicenter prospective studies are needed to determine the utility of RT in this patient population.
METHODS: The PubMed database was searched for studies including individualized data of patients undergoing GTR with or without RT for spinal chordoma. Patients < 18 years of age or those who underwent stereotactic body RT were excluded. Qualitative assessment was performed using Newcastle-Ottawa Scale guidelines. Log-rank tests for time-to-event data and a Cox proportional-hazards model were generated for a multivariable statistical model.
RESULTS: Complete data of 132 patients were retrieved, with 37 (28%) patients receiving adjuvant RT and 95 (72%) not receiving adjuvant RT. The mean follow-up was not statistically significantly different between those undergoing RT and not undergoing RT (54.02 months and 65.43 months, respectively). Patients were more likely not to undergo RT if their disease was located in the sacrum versus the mobile spine (p < 0.001). When controlling for age ≥ 65 years, male sex, disease location, and treatment year ≥ 2010, patients undergoing RT had similar PFS and OS when compared with those not undergoing RT on multivariable survival analysis (HR 0.935 [95% CI 0.703-2.340], p = 0.844 and HR 2.078 [95% CI 0.848-5.090], p = 0.110, respectively). However, age ≥ 65 years was associated with poorer OS in adjusted analyses (HR 2.761 [95% CI 1.185-6.432], p = 0.018) relative to patients < 65 years of age.
CONCLUSIONS: After achieving GTR of spinal chordoma, the utility of RT on PFS and OS remains unclear. Age ≥ 65 years appears to be associated with OS in spinal chordoma patients. Additional multicenter prospective studies are needed to determine the utility of RT in this patient population.
摘要：
目的：脊柱脊索瘤治疗指南推荐切除。然而,在实现全切除（GTR）的患者中，放射治疗(RT)的益处尚不清楚.因此,作者进行了系统评价,以确定RT是否与脊柱脊索瘤达到GTR后的术后无进展生存期(PFS)或总生存期(OS)相关.
方法：在PubMed数据库中搜索研究，包括接受GTR伴或不伴脊柱脊索瘤RT的患者的个性化数据。年龄<18岁的患者或接受立体定向放疗的患者被排除在外。使用纽卡斯尔-渥太华量表指南进行定性评估。对于多变量统计模型，生成了事件发生时间数据的对数秩检验和Cox比例风险模型。
结果：检索了132例患者的完整数据，37例（28%）患者接受辅助RT，95例（72%）患者未接受辅助RT。接受RT和未接受RT的患者的平均随访时间无统计学差异（54.02个月和65.43个月，分别)。如果患者的疾病位于骶骨而不是活动脊柱，则患者更有可能不接受RT（p<0.001）。当控制年龄≥65岁时，男性,疾病位置,在多变量生存分析中，接受RT的患者与未接受RT的患者相比具有相似的PFS和OS（HR0.935[95％CI0.703-2.340]，p=0.844和HR2.078[95%CI0.848-5.090]，分别为p=0.110)。然而,在校正分析中，年龄≥65岁与OS较差相关(HR2.761[95%CI1.185-6.432]，p=0.018）相对于<65岁的患者。
结论：达到脊柱脊索瘤GTR后，RT在PFS和OS上的实用性尚不清楚。年龄≥65岁似乎与脊柱脊索瘤患者的OS相关。需要额外的多中心前瞻性研究来确定RT在该患者人群中的实用性。
方法：在PubMed数据库中搜索研究，包括接受GTR伴或不伴脊柱脊索瘤RT的患者的个性化数据。年龄<18岁的患者或接受立体定向放疗的患者被排除在外。使用纽卡斯尔-渥太华量表指南进行定性评估。对于多变量统计模型，生成了事件发生时间数据的对数秩检验和Cox比例风险模型。
结果：检索了132例患者的完整数据，37例（28%）患者接受辅助RT，95例（72%）患者未接受辅助RT。接受RT和未接受RT的患者的平均随访时间无统计学差异（54.02个月和65.43个月，分别)。如果患者的疾病位于骶骨而不是活动脊柱，则患者更有可能不接受RT（p<0.001）。当控制年龄≥65岁时，男性,疾病位置,在多变量生存分析中，接受RT的患者与未接受RT的患者相比具有相似的PFS和OS（HR0.935[95％CI0.703-2.340]，p=0.844和HR2.078[95%CI0.848-5.090]，分别为p=0.110)。然而,在校正分析中，年龄≥65岁与OS较差相关(HR2.761[95%CI1.185-6.432]，p=0.018）相对于<65岁的患者。
结论：达到脊柱脊索瘤GTR后，RT在PFS和OS上的实用性尚不清楚。年龄≥65岁似乎与脊柱脊索瘤患者的OS相关。需要额外的多中心前瞻性研究来确定RT在该患者人群中的实用性。
