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Chordoma of the Mobile Spine and Sacrum: A Retrospective Analysis of a Series of Patients Surgically Treated at Two Referral Centers

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chordoma is a rare tumor, and its natural history is still not well known.

Materials and Methods

All patients affected by localized chordoma surgically treated at Istituto Ortopedico Rizzoli, Bologna, and Istituto Nazionale Tumori, Milan, Italy, between 1980 and 2008 were reviewed. Local recurrence, distant metastasis, and overall survival (OS) were analyzed both from time of diagnosis and from time of local recurrence/distant metastasis. A multivariable analysis to identify independent prognostic factors was carried out.

Results

A total of 138 consecutive patients were identified (sacrum 78%, lumbar spine 15%, cervical-dorsal spine 7%). Of these, 130 underwent surgical resection. Median follow-up was 142 months. The 5- and 10-year OS, local relapse-free survival (LRFS), and distant relapse-free survival (DRFS) were, respectively, 78% and 54%, 52% and 33%, and 86% and 72%. Size was an independent prognostic factor for OS (P value < .001), LRFS (P value: .038), and DRFS (P value: .004), while surgical margins independently predicted LRFS (P value: .003) with a trend for OS. The 5- and 10-year OS, LRFS, and DRFS after the first local relapse were 50% and 26%, 47% and 31%, and 64% and 61%. The size of the recurrence and quality of surgical margins did not influence postrelapse OS. The 5-year OS after the second local relapse was 19%. 22% of patients developed distant metastases with a 5-year post-metastases OS of 33%.

Conclusions

Tumor size and surgical margins affected outcome only on initial presentation. However, wide surgery was feasible in a minority of cases. Most patients died of local–regional disease even when metastases occurred. Indeed, long-term prognosis was such that disease-free survival at 10 years was only 26%.

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Authors and Affiliations

  1. Department of Cancer Medicine, Istituto Nazionale Tumori, Milan, Italy

    Silvia Stacchiotti MD, Paolo Giovanni Casali MD & Elena Palassini MD

  2. Unit of Clinical Epidemiology and Trial Organization, Istituto Nazionale Tumori, Milan, Italy

    Salvatore Lo Vullo BSc & Luigi Mariani MD

  3. Division of Orthopedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Mario Mercuri MD

  4. Division of Pathology, Istituto Ortopedico Rizzoli, Bologna, Italy

    Marco Alberghini MD & Licciana Zanella MD

  5. Department of Pathology and Molecular Biology, Istituto Nazionale Tumori, Milan, Italy

    Silvana Pilotti MD

  6. Department of Surgery, Istituto Nazionale Tumori, Milan, Italy

    Alessandro Gronchi MD

  7. Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna, Italy

    Piero Picci MD

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  1. Silvia Stacchiotti MD
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  2. Paolo Giovanni Casali MD
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  3. Salvatore Lo Vullo BSc
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  4. Luigi Mariani MD
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  9. Licciana Zanella MD
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Correspondence to Silvia Stacchiotti MD.

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Stacchiotti, S., Casali, P.G., Lo Vullo, S. et al. Chordoma of the Mobile Spine and Sacrum: A Retrospective Analysis of a Series of Patients Surgically Treated at Two Referral Centers. Ann Surg Oncol 17, 211–219 (2010). https://doi.org/10.1245/s10434-009-0740-x

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  • DOI: https://doi.org/10.1245/s10434-009-0740-x

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