Surgical Consideration for Patients with Repeatedly Recurrent Spinal Chordoma: A Systematic Analysis of Prognostic Factors and Quality of Life

Abstract

Background: A retrospective study of patients with repeatedly recurrent spinal chordoma (RRSC) was performed. The objective of this study was to evaluate the independent prognostic factors for RRSC improving life expectancy and discuss the most appropriate treatment modality. Methods: Medical data and follow-up record of patients who were diagnosed as RRSC and were surgically treated in Changzheng hospital between July 2010 and September 2017 were reviewed systematically. Univariate and multivariate analysis were performed to identify possible independent prognostic factors for patients with RRSC. Recurrence-free survival (RFS) and overall survival (OS) were estimated by Kaplan-Meier method. Factors with P < 0.1 were subjected to multivariate analysis by Cox regression analysis. P < 0.05 was considered statistically significant. Results: Sixty-five consecutive patients with RRSC were included in this study. Local recurrence was detected in thirty-three patients, while death was occurred in twenty-one patients. The mean follow-up period was 34.3 months. The statistical results revealed that number of recurrence (NOR), surgical method, and surgical margin were independent prognostic factors for RFS and preoperative Frankel score (PFS) was favorable prognostic factor for OS. Moreover, subtype analysis suggested that treatment method could make significant difference for prognosis of patients with RRSC. Conclusion: Less NOR, total resection, and wide surgical margin could significantly reduce the risk of local recurrence of RRSC. PFS of A-C was adverse prognostic factor for OS. Total en bloc resection or total piecemeal resection with postoperative radiotherapy is recommended as ideal treatment method for prolonging life expectancy.