Purpose:In this retrospective study, we compared the impact of en bloc resection with negative margins to that of intralesional resection followed by adjuvant radiotherapy on local control (LC) and overall survival (OS) in patients with mobile spine chordomas. Secondary endpoints included mechanical complication rates, associated risk factors, and quality of life outcomes.Methods: Between June 2008 and March 2025, 26 patients aged ≥ 15 years with mobile spine (C1–L5) chordomas underwent surgical treatment at our institution. Patients were divided into en bloc resection (=Enneking appropriate (EA)) and intralesional resection (=Enneking inappropriate (EI)) plus HT groups. Clinical, oncologic, and surgical data were collected and analyzed to determine outcomes.Results: The EA group demonstrated a clear trend toward improved local recurrence-free survival (LRFS, EA median 35 months vs. EI resection median 14 months) and OS. Adjuvant therapy led to better LRFS and OS independently of the extent of resection. Clinical outcomes and quality of life were favorable in both groups, with no statistically significant differences in short-term, as well as long-term complications (27%). No specific risk factors for long-term complications were identified.Conclusions: En bloc resection remains the gold standard for mobile spine chordoma resection whenever feasible. Nevertheless, Enneking-appropriate resection is often limited by anatomical constraints. In such cases, every effort should still be made to achieve the most complete tumor resection possible prior to initiating adjuvant therapy. Due to the rarity of spinal chordomas and their surgical complexity, these procedures should be performed in specialized spine centers with multidisciplinary expertise.
目的：本研究回顾性比较了整块切除联合阴性切缘与病灶内切除联合辅助放疗对活动性脊柱脊索瘤患者局部控制率及总生存期的影响。次要终点包括机械并发症发生率、相关风险因素及生活质量评估。 方法：2008年6月至2025年3月期间，我院收治的26例年龄≥15岁的活动性脊柱（C1-L5）脊索瘤患者接受手术治疗。患者分为整块切除组（符合Enneking原则组）和病灶内切除组（不符合Enneking原则组）联合辅助放疗组。收集并分析临床、肿瘤学及手术数据以评估治疗结果。 结果：整块切除组在局部无复发生存期（中位35个月 vs 病灶内切除组14个月）和总生存期方面均呈现明确改善趋势。辅助治疗可独立于切除范围改善局部无复发生存期与总生存期。两组临床结局与生活质量均表现良好，短期及长期并发症发生率（27%）无统计学显著差异。未发现明确的长期并发症风险因素。 结论：在可行情况下，整块切除仍是活动性脊柱脊索瘤手术的金标准。然而符合Enneking原则的切除常受解剖结构限制。在此情况下，仍应尽最大努力在辅助治疗前实现最彻底的肿瘤切除。鉴于脊柱脊索瘤的罕见性及手术复杂性，此类手术应在具备多学科专业能力的脊柱专科中心开展。
As Radical as Technically Feasible—Surgical Treatment for Mobile Spine Chordoma
肿瘤(癌症)患者之家