Prognostic factors in chordoma of the sacrum and mobile spine - A study of39 patients

BACKGROUND, The prognosis of patients with chordoma of the sacrum and mobil e spine has been reported to be dismal and attributable in the majority of cases to intralesional surgery. The purpose of this study was to evaluate t he clinical outcome of these patients using modern surgical principles aime d at complete resection and to identify prognostic factors. METHODS, The clinical and morphologic features, type of surgery, and follow -up of 39 consecutive patients with chordoma were reviewed and analyzed sta tistically. RESULTS. Thirty sacral and 9 mobile spine chordomas (size range, 3-20 cm; m ean, 8 cm) occurring in 22 women and 17 men (median age, 55 years) were ana lyzed. The preoperative morphologic diagnosis was based on fine-needle aspi ration (FNA) biopsy core needle biopsy, or incisional biopsy. The final sur gical margins were wide in 23 patients and marginal or intralesional in 16. The mean follow-up was 8.1 years (range, 0.1-23 pears). Seventeen patients (44%) developed local recurrences and 11 patients (28%) developed metastas es. The estimated 5-, 10-, 15-, and 20-year survival rates were 84%, 64% 52 %, and 52%, respectively. Local recurrence was associated significantly wit h an increased risk of metastasis and tumor-related death (P < 0.001). CONCLUSIONS. New surgical techniques have improved local control and surviv al of patients with sacral or spinal chordoma significantly and have decrea sed progressive neurologic deterioration. Larger tumor size, performance of an invasive morphologic diagnostic procedure outside of the tumor center, inadequate surgical margins, microscopic tumor necrosis, Ki-67 > 5%, and lo cal recurrence were found to be adverse prognostic factors. FNA is the pref erred method for establishing the preoperative morphologic diagnosis of cho rdoma. (C) 2000 American Cancer Society.