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Surgical Management of Spinal Chondrosarcomas

机译：脊柱软骨肉瘤的外科治疗

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Study Design.An ambispective cohort study.Objective.The aim of this study was to determine whether the application of the Enneking classification in the management of spinal chondrosarcomas influences local recurrence and survival.Summary of Background Data.Primary spinal chondrosarcomas are rare. Best available evidence is based on small case series, thus making it difficult to determine optimal management and risk factors for local recurrence and survival.Methods.The AOSpine Knowledge Forum Tumor developed a multicenter ambispective database of surgically treated patients with spinal chondrosarcoma. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Tumors were classified according to the Enneking classification. Patients were divided into two cohorts: Enneking appropriate (EA) and Enneking inappropriate (EI). They were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation, and otherwise, they were categorized as EI.Results.Between 1987 and 2011, 111 patients (37 female; 74 male) received surgical treatment for a primary spinal chondrosarcoma at a mean age of 47.415.8 years. Patients were followed for a median period of 3.1 years (range=203 d-18.7 yrs). Median survival for the entire cohort was 8.4 years postoperative. After 10 years postoperative, 36 (32%) patients died and 37 (35%) patients suffered a local recurrence. Twenty-three of these 37 patients who suffered a local recurrence died. Sixty (58%) patients received an EA procedure while 44 (42%) received an EI procedure. EI patients had a higher hazard ratio for local recurrence than those who received an EA procedure (P=0.052). Local recurrence was strongly associated with chondrosarcoma-related death (risk ratio=3.6, P<0.010).Conclusion.This is the largest multicenter cohort of spinal chondrosarcomas. EA surgical management appeared to correlate with a decreased risk of local recurrence, yet no relationship with survival was found. Where possible, surgeons should strive to achieve EA margins to minimize the risk of local recurrence.Level of Evidence: 4
机译：研究设计：一项有前瞻性的队列研究。目的：本研究的目的是确定Enneking分类法在管理脊椎软骨肉瘤中的应用是否会影响局部复发和生存。最佳的现有证据是基于小病例系列的，因此难以确定局部复发和生存的最佳治疗方法和风险因素。方法：AOSpine知识论坛肿瘤建立了一个多中心的，有角度的手术治疗脊柱软骨肉瘤患者的数据库。收集有关人口统计学，诊断，治疗，横断面生存率和局部复发的患者数据。根据Enneking分类对肿瘤进行分类。将患者分为两个队列：适当接受（EA）和适当接受（EI）。当边缘的最终病理评估与Enneking建议相符时，他们被归类为EA，否则，他们被归为EI。结果.1987年至2011年之间，有111例患者（37名女性; 74名男性）接受了原发性脊柱外科手术治疗软骨肉瘤平均年龄为47.415.8岁。随访患者的中位时间为3.1年（范围= 203 d-18.7岁）。整个队列的中位生存期为术后8.4年。术后10年后，有36名（32％）患者死亡，37名（35％）患者局部复发。在这37例局部复发的患者中，有23例死亡。六十（58％）患者接受了EA程序，而44（42％）患者接受了EI程序。 EI患者的局部复发风险比接受EA手术的患者高（P = 0.052）。局部复发与软骨肉瘤相关的死亡密切相关（风险比= 3.6，P <0.010）。结论。这是最大的脊柱软骨肉瘤多中心队列。 EA手术管理似乎与局部复发风险降低相关，但未发现与生存有关。在可能的情况下，外科医生应努力获得EA的余量，以最大程度地减少局部复发的风险。证据等级：4

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