Table_1_Surgical Treatment of Intra- and Juxtamedullary Spinal Cord Tumors: A Population Based Observational Cohort Study.XLSX

Objective: Intramedullary spinal cord tumors (IMSCT) are rare entities and high-level evidence regarding optimal treatment is lacking. We aim to describe the demographics, histopathological distribution, onset symptoms, treatment strategies, and functional outcome for patients surgically treated for IMSCT.
Methods: We performed a retrospective review of a consecutive population-based cohort of 95 patients who underwent surgery for intra- or juxtamedullary tumors at a single institution during the period 2004–2017.
Results: When gross total resection (GTR) was achieved, we found no case of local tumor recurrence even in the absence of adjuvant radio- or chemotherapy. Meanwhile, we found a 50% progression rate on long-term MRI follow-up in patients where only a partial resection was possible. At long-term follow-up, there was no significant alteration in functional status, while a significant reduction in share of patients reporting pain, compared to preoperative status, was identified. Poor preoperative functional status and postoperative tumor remnant were identified as individual risk factors for further functional decline.
Conclusion: Gross total resection, with minimal post-operative neurological deterioration, is possible in the majority of the cases, especially in the presence of an identifiable resection plane between tumor and healthy spinal cord. Since long-term progression-free survival could be achieved by GTR without additional adjuvant treatment, we emphasize that low-grade tumors should not be subject to radiotherapy. Treatment of high-grade or diffusely infiltrating tumors, tumor remnants, or metastases should be individualized.

研究目的：脊髓内肿瘤（Intramedullary Spinal Cord Tumors, IMSCT）属于罕见病症，目前缺乏针对其最优治疗方案的高级别循证医学证据。本研究旨在描述接受手术治疗的IMSCT患者的人口学特征、组织病理学分布、起病症状、治疗策略及功能预后情况。
研究方法：本研究对2004年至2017年间，在单中心接受脊髓内或髓旁肿瘤手术治疗的95例连续入组的基于人群队列患者，开展了回顾性分析。
研究结果：本研究发现，实现全瘤切除术（Gross Total Resection, GTR）的患者，即便未辅以辅助放疗或化疗，也未出现局部肿瘤复发的病例。与此同时，仅能实现部分切除术的患者，其长期磁共振成像（Magnetic Resonance Imaging, MRI）随访的肿瘤进展率达50%。在长期随访中，患者的功能状态未出现显著改变，但相较于术前状态，报告疼痛症状的患者占比显著降低。术前功能状态不佳及术后存在肿瘤残留，被确定为发生进一步功能减退的独立危险因素。
研究结论：多数病例可实现全瘤切除术，且术后神经功能恶化程度轻微，尤其是当肿瘤与健康脊髓间存在可辨识的切除平面时。由于全瘤切除术无需额外辅助治疗即可实现长期无进展生存期，本研究强调低级别肿瘤不应接受放疗。而高级别、弥漫浸润性肿瘤、肿瘤残留或转移瘤的治疗则应实现个体化。