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Surgical treatment of sacral chordoma: prognostic variables for local recurrence and overall survival

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Abstract

Purpose

Sacral chordomas (SC) are rare, locally invasive, malignant neoplasms. Despite surgical resection and adjuvant therapies, local recurrence (LR) is common and overall survival (OS) is poor. The objective of this study was to identify prognostic factors that have an impact on the local recurrence-free survival (LRFS) and OS of patients with SC.

Methods

Utilizing the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated SC cases were identified. Cox regression modeling was used to assess the effect of several clinically relevant variables on OS and LRFS.

Results

A total of 167 patients with surgically treated SC were identified. The male/female ratio was 98/69 with a mean age of 57 ± 15 years at the time of surgery. The LR was 35 % (n = 57), death occurred in 30 % of patients (n = 50) during the study period. The median OS was 6 years post-surgery and LRFS was 4 years. In the univariate analysis, previous tumor surgery at the same site (P = 0.002), intralesional resection (P < 0.001), and larger tumor volume (P = 0.030) were significantly associated with LR. Increasing age (P < 0.001) and a preoperative motor deficit of C or D (P = 0.003) were significantly associated with poor OS, and nerve root sacrifice showed a trend towards significance (P = 0.088). In the multivariate models, previous surgery and intralesional resection were significantly related to LR, while increasing age and motor deficit of C or D were associated with poor OS.

Conclusions

This study identified two predictive variables for LRFS (previous tumor surgery and type of surgical resection) and two for OS (age and impaired motor function) in surgically treated SC patients. Our results indicate that en bloc resection reduces LR but does not influence OS. However, this was likely due to short follow-up (3.2 years).

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Acknowledgments

We are grateful to the collaborating centers’ local clinical research personnel and support staff for their active participation. This study was organized and funded by AOSpine International, through the AOSpine Knowledge Forum Tumor, a pathology-focused working group of up to ten international spine experts acting on behalf of AOSpine in the domain of scientific expertise. Study support was provided directly through AOSpine’s Research department and AO’s Clinical Investigation and Documentation unit.

Conflict of interest

The authors have no financial conflicts of interest.

Author information

Authors and Affiliations

  1. National Center for Spinal Disorders, Kiralyhagó Street 1-3, 1126, Budapest, Hungary

    Péter Pál Varga, Zsolt Szövérfi & Aron Lazary

  2. Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, Vancouver, BC, Canada

    Charles G. Fisher

  3. Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute, Bologna, Italy

    Stefano Boriani

  4. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ziya L. Gokaslan

  5. Department of Orthopaedic Surgery, The CORE Institute, Sun City West, AZ, USA

    Mark B. Dekutoski

  6. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA

    Dean Chou

  7. Queens Medical Centre, Nottingham University Hospital NHS Trust, Nottingham, UK

    Nasir A. Quraishi

  8. Spinal Division, Nuffield Orthopedic Centre, University of Oxford, Oxford, UK

    Jeremy J. Reynolds

  9. Oncologia Ortopedica e Ricostruttiva del Rachide, Istituto Ortopedico Galeazzi, Milan, Italy

    Alessandro Luzzati

  10. Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, QLD, Australia

    Richard Williams

  11. Division of Neurosurgery and Spinal Program, Department of Surgery, University of Toronto and Toronto Western Hospital, Toronto, ON, Canada

    Michael G. Fehlings

  12. Research Department, AOSpine International, Davos, Switzerland

    Niccole M. Germscheid

  13. Department of Neurosurgery, MD Anderson Cancer Center, The University of Texas, Houston, TX, USA

    Laurence D. Rhines

  14. Semmelweis University, School of Ph.D. Studies, Budapest, Hungary

    Zsolt Szövérfi

Authors
  1. Péter Pál Varga
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  2. Zsolt Szövérfi
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  3. Charles G. Fisher
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  4. Stefano Boriani
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  5. Ziya L. Gokaslan
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  6. Mark B. Dekutoski
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  7. Dean Chou
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  8. Nasir A. Quraishi
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  9. Jeremy J. Reynolds
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  10. Alessandro Luzzati
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  11. Richard Williams
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  12. Michael G. Fehlings
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  13. Niccole M. Germscheid
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  14. Aron Lazary
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  15. Laurence D. Rhines
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Corresponding author

Correspondence to Péter Pál Varga.

Additional information

P. P. Varga and Z. Szövérfi are co-first authors.

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Varga, P.P., Szövérfi, Z., Fisher, C.G. et al. Surgical treatment of sacral chordoma: prognostic variables for local recurrence and overall survival. Eur Spine J 24, 1092–1101 (2015). https://doi.org/10.1007/s00586-014-3728-6

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  • DOI: https://doi.org/10.1007/s00586-014-3728-6

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