Abstract
Introduction
Sacral chordomas are rare, locally invasive, malignant neoplasms. Although, their surgical and oncological therapy has changed significantly over the last few decades, the prognosis is still poor. The objective of this study was to identify factors that have an impact on the overall and local recurrence-free survival of patients with sacral chordoma.
Materials and Methods
Utilizing the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated sacral chordoma cases were identified. Kaplan–Meier, log-rank test, and Cox regression modeling were used to assess the effect of several pre-, peri-, and postoperative variables on overall survival and local recurrence-free survival.
Results
A total of 167 patients with surgically treated sacral chordoma were identified. The male/female ratio was 98:69 with a mean age of 57 years (SD = 15) at the time of surgery (18–89 years). The local recurrence occurred in 35% (n = 57) and death occurred in 30% of the patients (n = 50) during the study period (5 days–16.2 years). The median overall survival was 6 years postsurgery and local recurrence-free survival was 4 years. In the univariate analysis, age (p < 0.001) and preoperative motor deficit (p = 0.003) were significantly associated with poor overall survival, and nerve root sacrifice showed a trend toward significance (p = 0.088). Previous tumor surgery at the same site (p = 0.002), intralesional resection (p < 0.001), and tumor volume (p = 0.030) were significantly associated with local recurrence. In the multivariate models, age and motor deficit were associated with poor survival, while previous surgery and intralesional resection were significantly related to local recurrence.
Conclusion
This study identifies two predictive variables for mortality (age and impaired motor function) and two for local recurrence (previous tumor surgery and intralesional surgery) in surgically treated sacral chordoma.