원발성 악성 척추 종양에서 수술적 절제 방법과 절제연의 임상적 의의: 다기관 후향적 연구 = Clinical Significance of Resection Type and Margin following Surgical Treatment for Primary Sarcoma of the Spine: A Multi-Center Retrospective Study

다국어 초록 (Multilingual Abstract)

Study Design: A retrospective multi-center study.
Objectives: To analyze oncological outcomes according to the resection type and surgical margin following surgical treatment for primary spinal sarcoma.
Summary of Literature Review: Previous studies using registry databases have shown that surgery and negative margins were associated with improved survival for primary spinal sarcoma. However, few studies have comprehensively analyzed the clinical significance of the resection type and surgical margin for the oncological outcomes of this rare malignancy.
Materials and Methods: We retrospectively reviewed consecutive patients who underwent surgical resection for primary spinal sarcoma between 1997 and 2016 at two tertiary medical centers. Overall survival and the occurrence of local recurrence and distant metastasis were compared between the groups using Kaplan-Meier curve analysis and the log-rank test.
Results: Thirty-three patients (21 males,12 females) with a mean age of 45.1 years and a median follow-up of 36 months were included. There were 13 (39.4%) chondrosarcomas, 12 (36.4%) osteosarcomas, and eight different histological diagnoses. The cohort was categorized into four groups: 1) total en bloc resection with a negative margin (n=12; 36.4%), 2) total en bloc resection with a positive margin: (n=5; 15.2%), 3) total piecemeal resection (n=12; 36.4%), and 4) subtotal resection (n=4; 12.1%). Total en bloc resection with a negative margin was associated with improved overall survival (p=0.030) and less distant metastasis (p=0.025) and local recurrence (p=0.004).
Conclusions: Achieving a negative margin through total en bloc resection, although technically demanding, improves oncological outcomes in primary spinal sarcoma.
Key words: Primary spinal sarcoma, En bloc resection, Survival, Recurrence, Metastasis

국문 초록 (Abstract)

연구 계획: 후향적 다기관 연구목적: 본 연구진은 원발성 악성 척추 종양 환자에서 절제 방법 및 수술 절제연이 생존 기간, 국소 재발 및 원격 전이 등 임상적 결과에 미치는 영향을 분석하고자 하였다.
선행 연구문헌의 요약: 원발성 악성 척추 종양에서 수술적 치료와 음성 절제연은 생존 기간의 연장 등 보다 좋은 임상 결과와 연관이 되어 있다고 알려져있다. 하지만 절제 방법 및 수술 절제연을 종합적으로 분석한 연구는 이제까지 많지 않았다.
대상 및 방법: 1997년부터 2016년까지 두 개의 기관에서 원발성 척추 종양으로 수술을 시행 받은 환자를 후향적으로 분석하였으며, 절제 방법(일괄 및분할)과 수술 절제연(양성 및 음성)이 생존 기간, 국소 재발 및 원격 전이 등에 미치는 영향을 생존 분석(Kaplan-Meier curve analysis and log rank test)으로 평가하였다.
결과: 총 33명(남자 21명, 여자 12명)의 환자가 연구에 포함되었으며, 평균 나이는 45.1세, 추시 기간의 중간값은 36개월이었다. 13(39.4%)예의 연골육종, 12(36.4%)예의 골육종이 가장 많은 조직학적 진단을 차지하였다. 전체 환자를 절제 방법 및 절제연을 기준으로 네 그룹으로 나누었을 때, 그 분포는다음과 같았다. 1) 완전 일괄 절제 (total en bloc resection) 및 음성 절제연: n=12(36.4%), 2) 완전 일괄 절제 및 양성 절제연: n=5(15.2%), 3) 완전 분할 절제 (total piecemeal resection): n=12(36.4%), and 4) 불완전 절제(subtotal resection): n=4(12.1%). 생존 분석을 시행하였을 때, 완전 일괄 절제 및 음성 절제연을 시행 받은 환자들에서 유의하게 긴 생존 기간(p=0.030), 적은 원격 전이 (p=0.025) 및 국소 재발 (p=0.004)의 발생이 관찰되었다.
결론: 원발성 악성 척추 종양에서 보다 좋은 종양학적 결과(oncological outcome)를 얻기 위해서는 완전 일괄 절제술을 통해 음성 절제연을 얻고자 하는노력이 필요하겠다.
약칭 제목: 원발성 척추암의 수술적 치료

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