In Reply: Cranial Chordoma: A New Preoperative Grading System

Silva, Harley Brito da; Sekhar, Laligam N.

doi:10.1093/neuros/nyy068

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“…The existing literature is instead focused on the prognostic implications of signal intensity on preoperative MRI 26,41,42 or a combination of clinico-radiological factors. 43 This is the first study investigating TGR as a predictor of chordoma aggressiveness after treatment.…”

Section: Discussionmentioning

confidence: 99%

Tumor Growth Rate as a New Predictor of Progression-Free Survival After Chordoma Surgery

et al. 2021

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BACKGROUND Currently, different postoperative predictors of chordoma recurrence have been identified. Tumor growth rate (TGR) is an image-based calculation that provides quantitative information of tumor's volume changing over time and has been shown to predict progression-free survival (PFS) in other tumor types. OBJECTIVE To explore the usefulness of TGR as a new preoperative radiological marker for chordoma recurrence. METHODS A retrospective single-institution study was carried out including patients reflecting these criteria: confirmed diagnosis of chordoma on pathological analysis, no history of previous radiation, and at least 2 preoperative thin-slice magnetic resonance images available to measure TGR. TGR was calculated for all patients, showing the percentage change in tumor size over 1 mo. RESULTS A total of 32 patients were retained for analysis. Patients with a TGR ≥ 10.12%/m had a statistically significantly lower mean PFS (P < .0001). TGR ≥ 10.12%/m (odds ratio = 26, P = .001) was observed more frequently in recurrent chordoma. In a subgroup analysis, we found that the association of Ki-67 labeling index ≥ 6% and TGR ≥ 10.12%/m was correlated with recurrence (P = .0008). CONCLUSION TGR may be considered as a preoperative radiological indicator of tumor proliferation and seems to preoperatively identify more aggressive tumors with a higher tendency to recur. Our findings suggest that the therapeutic strategy and clinical-radiological follow-up of patients with chordoma can be adapted also according to this new parameter.

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