Prognosis and Risk Factors Influencing Recurrence in Surgery-treated Patients with Primary Sacral Tumors
Abstract
Background: We aimed to explore the prognosis and risk factors influencing tumor recurrence in surgery-treated patients with primary sacral tumors.
Methods: Fifty-six patients between February 2011 and December 2016 in Yishui Central Hospital with primary sacral tumors were selected and treated with radical surgeries. The perioperative outcomes and postoperative neurological functions were observed. After postoperative follow-up, the overall survival time (OS), disease-free survival time (DFS), and recurrence were recorded to analyze the potential risk factors influencing tumor recurrence.
Results: The average surgical duration and intraoperative hemorrhagic volume were 3.92 ± 1.46 h and 2, 348.21 ± 813.67 ml, respectively. The postoperative short-term complications included three patients with infection from obstructed drainage and two with skin flap necrosis-induced infection, who recovered after anti-infection therapies; nine with incision-edge necrosis; two with calf muscle venous thrombosis; and one with an endorhachis cerebrospinal fluid fistula, who recovered after conventional treatment. Among patients, the 1-, 2- and 3-year survival rates were 91.07% (51/56), 82.14% (46/56), and 75.00% (42/56) while the 1-, 2- and 3-year DFS rates were 89.29% (50/56), 78.57% (44/56) and 71.43% (40/56), respectively. Of the 56 patients, 16 had recurrence after surgery, with recurrence rate of 28.57%. It was predicated that surgical methods and local infiltration were the independent risk factors influencing tumor recurrence (P<0.01).
Conclusion: The reservation of bilateral S3 or > unilateral S3 nerves can improve quality of life of patients. Surgical methods and local infiltration are the independent risk factors influencing tumor recurrence, and extensive resection can effectively control the recurrence rate.
Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, and Eismont FJ (2006). Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am, 88 (7): 1532-9.
Ruggieri P, Huch K, Mavrogenis AF, Merlino B, Angelini A (2014). Osteoblastoma of the sacrum: report of 18 cases and analysis of the literature. Spine (Phila Pa 1976), 39 (2): E97-E103.
Varga PP, Szövérfi Z, Lazary A (2014). Surgical treatment of primary malignant tumors of the sacrum. Neurol Res, 36 (6): 577-87.
Zhang K, Chen H, Wu G, Chen K, Yang H (2014). High expression of SPHK1 in sacral chordoma and association with patients' poor prognosis. Med Oncol, 31 (11): 247.
Zhou M, Yang H, Chen K, Wang G, Lu J, Ji Y, Wu C, Chen C, Hu H (2013). Surgical treatment of giant cell tumors of the sacrum and spine combined with pre-operative transarterial embolization. Oncol Lett, 6 (1): 185-90.
van der Heijden L, van de Sande MA, van der Geest IC et al (2014). Giant cell tumors of the sacrum--a nationwide study on midterm results in 26 patients after intralesional excision. Eur Spine J, 23 (9): 1949-62.
Guo W, Ji T, Tang X, Yang Y (2009). Outcome of conservative surgery for giant cell tumor of the sacrum. Spine (Phila Pa 1976), 34 (10): 1025-31.
Arıkan M, Togral G, Hastürk AE, Aktaş E, Güngör S (2014). Management and retrospective analysis of primary and metastatic sacral tumors and infections: evaluation with 73 cases. Eklem Hastalik Cerrahisi, 25 (3): 126-32.
Varga PP, Lazary A (2010). Chordoma of the sacrum: "en bloc" high partial sacrectomy. Eur Spine J, 19 (6): 1037-8.
Gonçalves VM, Lima A, Gíria J, Carvalho N, Parreira J, Cunha E Sá M (2014). Modified kraske procedure with mid-sacrectomy and coccygectomy for en bloc excision of sacral giant cell tumors. Case Rep Surg, 2014: 834537.
Sun J, Wang Z, Li Z, Wu H, Yen R, Zheng M, Chang Q, Liu IY (2013). Reconstruction of nerve root sheaths for sacral extradural spinal meningeal cysts with spinal nerve root fibers. Sci China Life Sci, 56 (11): 1007-13.
Li G, Fu D, Chen K, Ma X, Sun M, Sun W, Li J, Cai Z (2012). Surgical strategy for the management of sacral giant cell tumors: a 32-case series. Spine J, 12 (6): 484-91.
Saigal R, Lu DC, Deng DY, Chou D (2014). Conversion of high sacral to midsacral amputation via S-2 nerve preservation during partial S-2 sacrectomy for chordoma. J Neurosurg Spine, 20 (4): 421-9.
Varga PP, Szövérfi Z, Fisher CG et al (2015). Surgical treatment of sacral chordoma: prognostic variables for local recurrence and overall survival. Eur Spine J, 24 (5):1092-101.
Ming Z, Kangwu C, Huilin Y, Genlin W, Jian L, Yiming J, Chunshen W, Chao C (2013). Analysis of risk factors for recurrence of giant cell tumor of the sacrum and mobile spine combined with preoperative embolization. Turk Neurosurg, 23 (5): 645-52.
| Files | ||
| Issue | Vol 46 No 8 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Surgical resection Sacral tumor Neurological function Recurrence Disease-free survival time | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
