Male sex as a risk factor for the clinical course of skull base chordomas

Rachinger, Walter; Eigenbrod, Sabina; Dützmann, Stephan; Simon, Matthias; Feigl, Guenther C.; Kremenevskaja, Natalia; Kretzschmar, Hans A.; Zausinger, Stefan; Kreth, Friedrich W.; Thon, Niklas; Tonn, Jörg C.

doi:10.3171/2013.11.jns131137

Cited by 25 publications

(11 citation statements)

References 32 publications

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“…This corresponded to the average age reported in most surgical series, except for that described by Jahangiri et al (59 years). 16,20,22,23,24,33 The mean time from initial symptoms to diagnosis is usually longer than 1 year 23,27 and was 18.8 months and 14.4 months in our present study and in a previously reported series, respectively. 33 Chordomas are indolent and slowgrowing tumors that are often clinically silent until the late stages of disease.…”

Section: Discussionsupporting

confidence: 60%

“…Skull base chordomas are locally invasive tumors with a slight male predilection, as shown in Table 3, in which the constituent ratio of males ranged from 49% to 70%. 2,6,16,20,22,23,24,28,33 There was a very wide spread of age at diagnosis in our series, ranging from 5 to 76 years, with a peak incidence in the fourth decade of life. This corresponded to the average age reported in most surgical series, except for that described by Jahangiri et al (59 years).…”

Section: Discussionmentioning

confidence: 68%

“…The KPS score was used to assess functional status during the perioperative period, as used by others. 9,22,24,28 Overall, the average KPS score was 76.4 ± 12.1 preoperatively and 75.4 ± 17.9 postoperatively before discharge. There was no significant difference between these values (p = 0.702), which may imply that surgery could not improve the postoperative short-term functional outcome of the patients as a whole.…”

Section: Surgical Complications and Managementmentioning

confidence: 97%

“…Because the definitions of resection degree are varied, 16,20,22,23,24,28,33 the rates of MargR from different reports cannot be rigorously compared. Compared with our previous report, 33 the overall MargR rate slightly declined in the present series.…”

Section: Factors Associated With Extent Of Resectionmentioning

confidence: 99%

“…The reported complication rates after surgery range from as low as 16% to as high as 60%. 22 Meningitis and CSF leakage ranked as the most common complications, and brain infarctions often led to severe functional deterioration. The incidence of CSF leakage was obviously less in this series than in the previous report, 33 which was due to some extent to technical improvements in skull base repair.…”

Section: Complication Ratesmentioning

confidence: 99%

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Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Wang

Tian

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Skull base chordoma is relatively rare, and a limited number of reports have been published regarding its clinical features. Moreover, the factors associated with extent of resection, as well as the value of marginal resection for long-term survival, are still in question for this disease. The objective of this study was to investigate these factors by evaluating their clinical features and surgical outcomes. METHODS A retrospective analysis of 238 patients with skull base chordomas, who met the inclusion criteria, was performed. This study summarized the clinical features, selection of approaches, degree of resection, and postoperative complications by statistical description analyses; proposed modified classifications of tumor location and bone invasion; studied the contributions of the clinical and radiological factors to the extent of resection by Pearson χ, ANOVA, rank test, and binary logistic regression analysis; and estimated the differences in overall survival and progression-free survival rates with respect to therapeutic history, classification of tumor location, extent of bone invasion, and extent of tumor resection by the Kaplan-Meier method. A p value < 0.05 was considered statistically significant. RESULTS The study included 140 male and 98 female patients with a mean age of 38.1 years. Headache and neck pain (33.2%) and diplopia (29%) were the most common initial symptoms. Sphenoclival type accounted for the largest proportion of tumor location (59.2%); endophytic chordoma was the more common type of bone invasion (81.5%). Lateral open approaches were performed in two-thirds of the study population (78.6%). The rate of marginal resection was 66%, composed of gross-total resection (11.8%) and near-total resection (54.2%). Meningitis (8%) and CSF leakage (3.8%) were the most frequent complications. The mean follow-up period was 43.7 months. The overall survival and progression-free survival rates at 5 years were 76% and 45%, respectively. Recurrent tumor and larger tumor volume (≥ 40 cm) were identified as risk factors of marginal resection. Patients who presented with recurrent tumor and underwent intralesional resection had a worse long-term outcome. CONCLUSIONS The classifications of both tumor location and bone invasion demonstrated clinical value. Marginal resection was more likely to be achieved for primary lesions with smaller volumes (< 40 cm). The rate of CSF leakage declined due to improved dura mater repair with free fat grafts. Marginal resection, or gross-total resection when possible, should be performed in patients with primary chordomas to achieve better long-term survival.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 68%

Section: Surgical Complications and Managementmentioning

confidence: 97%

Section: Factors Associated With Extent Of Resectionmentioning

confidence: 99%

Section: Complication Ratesmentioning

confidence: 99%

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Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Wang

Tian

et al. 2017

Journal of Neurosurgery

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Comprehensive Management of Chordoma

Kshettry

Venur

et al. 2017

Textbook of Uncommon Cancer

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Clival chordomas and chondrosarcomas in Denmark—Outcomes in 33 patients following the national centralization of treatment in 2010

Skotting,

Poulsgaard,

Springborg

et al. 2024

Acta Neurochir

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Purpose This 13-year consecutive case series aims to provide a comprehensive overview of all patients operated for clival chordomas and clival chondrosarcomas in Denmark since the centralization of treatment in 2010, comparing outcomes to international series. Methods This was a retrospective review of 33 patients with clival tumors, comprising 22 chordomas and 11 chondrosarcomas, who were treated at Copenhagen University Hospital between years 2010 and 2023. Data were collected from digital patient records and pathology reports. Results The symptoms leading to diagnosis primarily included double vision, headaches, and dizziness. In general, patients were in good health, with a mean Charlson Comorbidity Index score of 1.6. The complication rate of the index surgery was 51.5%. Adjuvant radiotherapy was applied in 51.5% of the cases. In patients with clival chordomas, the mean age was 51.1 years, ranging from 16 to 83 years. At the time of diagnosis, the mean tumor volume was 20.9 cm3 and the five-year overall survival rates were 79.1% (95% confidence interval (CI): 62.4–100). In patients with chondrosarcomas, the mean age was 48.2 years, ranging from 15 to 76 years. At the time of diagnosis, the mean tumor volume was 22.3 cm3 and the five-year overall survival 90% (95% CI: 73.2–100). Conclusion The centralized treatment of clival tumors in Denmark demonstrates incidence, survival, and complication rates comparable to those found in other international series. Given the variations in treatment strategies, tumor localizations across series, and small sample sizes, the further analysis of larger compiled multicenter datasets for clival tumors could provide more solid evidence regarding the management of these rare tumors.

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Male sex as a risk factor for the clinical course of skull base chordomas

Abstract: In skull base chordomas, male patients bear a higher risk of progressive disease and death. Male patients might benefit from more aggressive adjuvant therapy and/or from a closer follow-up schedule.

Cited by 25 publications

References 32 publications

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Clinical features and surgical outcomes of patients with skull base chordoma: a retrospective analysis of 238 patients

Comprehensive Management of Chordoma

Clival chordomas and chondrosarcomas in Denmark—Outcomes in 33 patients following the national centralization of treatment in 2010

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