Sacral Chordoma: 40-Year Experience at a Major Cancer Center

York, Julie E.; Kaczaraj, Adriana; Abi-Said, Dima; Fuller, Gregory N.; Skibber, John M.; Janjan, Nora A.; Gokaslan, Ziya L.

doi:10.1097/00006123-199901000-00041

Cited by 394 publications

(271 citation statements)

References 15 publications

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“…Despite a similar trend of the surgical margin and previous surgery in conditional survival over time, an inadequate margin and previous surgery before referral continued to have a lower 5-year conditional survival, which is consistent with previous studies demonstrating that the surgical margin is an important predictor of survival [9,23,26,34,38,42]. The surgical margin is the main predictor factor for local control and disease-free survival [3,11,24,44]. Intralesional surgery resulted in a high recurrence rate.…”

Section: Figsupporting

confidence: 85%

“…Intralesional surgery resulted in a high recurrence rate. York et al [44] reported a 83% local recurrence rate of sacral chordoma after intralesional surgery. In the current study, all 16 patients who received primary surgery with an inadequate margin before referral developed local recurrence.…”

Section: Figmentioning

confidence: 99%

“…Chordoma is the most common malignant primary tumor arising from the sacrum. Approximately 50% of spinal chordomas originate in the sacrum [7,22,44]. Sacral chordomas tend to be large at the time of diagnosis and often require en bloc resection for long-term disease-free survival [3,12,25,29,39].…”

Section: Introductionmentioning

confidence: 99%

“…Sacral chordomas tend to be large at the time of diagnosis and often require en bloc resection for long-term disease-free survival [3,12,25,29,39]. Several studies have demonstrated that a negative surgical margin is the most important predictor of the local recurrence rate and survival [3,12,13,44]; however, wide resection is not achieved in 35% to 75% of patients undergoing surgery for this diagnosis [42]. Surgery in this anatomic site is challenging as a result of the complexity of the pelvic anatomy, adjacent visceral and vascular structures, and frequent compromise of spinopelvic continuity [12,17,32].…”

Section: Introductionmentioning

confidence: 99%

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What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Guo

Yang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Conditional survival is a measure of prognosis for patients who have already survived for a specific period of time; however, data on conditional survival after sacrectomy in patients with sacral chordoma are lacking. In addition, because sacral tumors are rare and heterogeneous, classifying them in a way that allows physicians to predict functional outcomes after sacrectomy remains a challenge. Questions/purposes (1) What is the overall survival and disease-free survival in patients treated by sacrectomy for chordoma? (2) What is the conditional survival probability and how do prognostic factors change over time in patients undergoing surgical resection for sacral chordoma? (3) What is the local recurrence rate after surgery, how was it treated, and what factors impact on local recurrence? (4) What is the postoperative motor, sensory, bowel, and bladder function by level of resection as determined by using a newly designed scoring method?Methods Between 2003 and 2012, our center treated 122 patients surgically for sacral chordoma. Of those, two died and five were lost before a minimum followup of 1 year was achieved, leaving 115 patients available for analysis in this retrospective study at a mean of 4.9 years (range, 1.3-10.8 years). Basically, single posterior or combined approaches were chosen based on the most cephalad extent of the tumor and resection level was normally at half or one sacral vertebrae above the tumor. The 5-year conditional survival rate was calculated based on Kaplan-Meier survival analysis. The effect of prognostic factors on conditional survival was also explored. A newly designed score method was proposed and adopted in the current study to critically evaluate the functional outcome after resection of the sacrum. Inter-and intraobserver reliability was tested by a preliminary study using kappa statistics and Spearman rank correlation coefficients. Significant interobserver (p\0.01) and intraobserver agreement (j[0.75) were found in nine items between each observer. Results The estimated 5-year overall survival rate was 81% (95% confidence interval [CI], 72%-90%) at diagnosis. The 5-year disease-free survival rate was 52% (95% CI, 43%-63%). The 5-year conditional overall survival decreased with each additional year in the first 4 years (81% at diagnosis versus 60% at the fourth year, p \ 0.0001) and increased slightly in the fifth year. Patients with adequate surgical margins displayed a higher 5-year survival than those with an inadequate margin (86% [95% CI, 76%-95%] versus 67% [95% CI, 48%-85%], p = 0.01) at diagnosis. Conditional survival estimates for patients who received operations elsewhere were lower than that of newly diagnosed patients treated by us at diagnosis (64% [95% CI, 46%-83%] versus 90% [95% CI, 82%-99%], p = 0.012), but with the numbers we had, we could not detect a difference in conditional survival between those treated elsewhere first compared with those initially treated by us at 5 years. The proposed score system for function evaluation was a...

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Section: Figsupporting

confidence: 85%

Section: Figmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

Guo

Yang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…5,8 Aggressive techniques of surgery allow a more total resection, but local recurrence rate is still high. [7][8][9] As many patients can survive despite the presence of symptoms, the use of CDFS time is potentially more valuable than the overall survival time. Therefore, we investigated the factors related with CDFS in sacral chordomas.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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.

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Imatinib mesylate in chordoma

Casali

Messina

Stacchiotti

et al. 2004

Cancer

252

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Drs. Casali, Colecchia, and Gronchi received research and educational grants, honoraria for lectures and/or participation in educational/scientific projects, and travel coverage for medical meetings from Novartis Pharma.Drs. Messina and Grosso received honoraria for lectures and/or participation in educational/scientific projects and travel coverage for medical meetings from Novartis Pharma.Drs. Tamborini and Bertulli received travel coverage for medical meetings from Novartis Pharma.Drs. Ripamonti and Pilotti received research/educational grants from Novartis Pharma.Raffaello Bertieri is employed by Novartis in the division of Clinical Development, Oncology Department.

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Sacral Chordoma: 40-Year Experience at a Major Cancer Center

Cited by 394 publications

References 15 publications

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

What Are the Conditional Survival and Functional Outcomes After Surgical Treatment of 115 Patients With Sacral Chordoma?

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

Imatinib mesylate in chordoma

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