Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients

Abstract

Study design: Retrospective study. Objectives: To investigate prognostic factors of sacral chordomas and provide theoretical foundation for an improvement of continuous disease-free survival (CDFS). Methods: Thirty-six patients underwent initial operation for sacral chordoma between 1992 and 2007. Data regarding age, gender, tumor size, tumor location, and type of surgery, surgical margins, surrounding muscle invasion, radiation therapy, and recurrences were reviewed and analyzed statistically. Results: The average duration of follow-up was 74.4 months (range, 16-182 months). Sixteen patients developed local recurrences at the time of final follow-up. The average recurrence time was 30 months (range, 3-84 months). The 5-year and 10-year actuarial CDFS were 59.5 and 42%, respectively. CDFS was found statistically longer in patients whose tumor highest level at or below S3 compared with above S3 (P ¼ 0.047). Patients who had invasion into the surrounding muscle had a shorter CDFS than those without surrounding muscle invasion (P ¼ 0.014). Statistic analysis showed that the type of surgery was the most valuable indicator of CDFS (P ¼ 0.001). The local recurrence rate was statistically higher when an inadequate margin has been achieved (P ¼ 0.021). The Cox multivariate regression analysis showed that surrounding muscle invasion (P ¼ 0.024) was an independent adverse prognostic factor for CDFS, whereas incomplete excision (P ¼ 0.056) achieved borderline significance. Conclusions: The higher level of tumor involvement, invasion into the surrounding muscle, incomplete excision, and inadequate surgical margins are poor prognostic factors. Resecting the tumor completely with wide surgical margins may provide a better prognosis for these patients.

Wide resection of sacral chordoma via a posterior approach

“…Wide or adequate resection is still the best treatment in chordoma of the sacrum even though most of the patients have permanent neurological deficit after tumor resection [7,8]. Resecting the tumor as completely as possible will decrease the chances of local recurrence of the sacral chordoma [9].…”

Maintenance of bowel, bladder, and motor functions after sacrectomy

“…Obtaining clear surgical margins is important for preventing tumor recurrence [4]. However, this typically necessitates the sacrifice of sacral nerves.…”

Role of the Apparent Diffusion Coefficient as a Predictor of Tumor Progression in Patients with Chordoma

“…Surgical resection is the standard therapy for chordoma, though there have been recent advances in radiation therapy (RT). [6][7][8][9][10][11] En bloc surgical resection with negative margins and no intraoperative spill is associated with a reduced rate of local recurrence. However, the location of the chordoma may limit the ability to perform a gross total resection.…”