Results following surgical resection of recurrent chordoma of the spine: experience in a single institution

Chanplakorn, Pongsthorn; Lertudomphonwanit, Thamrong; Homcharoen, Wittawat; Suwanpramote, Prakrit; Laohacharoensombat, Wichien

doi:10.1186/s12957-020-02005-4

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…For chordomas, wide en-bloc resection is not always possible, either because of the size or extent of the tumor or because such resection would lead to excessive morbidity ( 25 ).The limitation of this paper is that we did not provide accurate information about postoperative margins, because only 10 patients in our study reported clear postoperative negative margins (R0 margins), and none of the rest recorded margins. This may affect the accuracy of prognosis.…”

Section: Discussionmentioning

confidence: 90%

Low expression of H3K27me3 is associated with poor prognosis in conventional chordoma

Wei

Yin³

et al. 2022

Front. Oncol.

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PurposeChordoma is a rare and locally invasive neoplasm, and the prognostic factors are limited. Deregulation of Histone 3 lysine 27 (H3K27) trimethylation (H3K27me3) is considered to be related with poor prognosis in some tumors. The purpose of this study was to detect the expression of H3K27me3 in chordomas and analyze the correlation with clinicopathological features and explore the roles as potential prognostic markers and therapeutic targets.Material and methodSpecimens of 162 chordoma patients (consisting of 156 conventional chordoma, 4 dedifferentiated chordoma and 2 poorly differentiated chordoma) were enrolled in a tissue microarray (TMA) in order to assess the immunohistochemical staining by H3K27me3 antibodies. Correlations between H3K27me3 expression and clinicopathological features were analyzed. Clinical data of the patients were correlated and survival analysis was performed. Kaplan-Meier survival curves and log-rank test were used to analyze the recurrence-free survival (RFS) and overall survival (OS). Multivariate Cox regression analyses were used to identify potential prognostic factors.ResultsThe expression of H3K27me3 was lower in 37 chordoma patients (37/162, 22.8%), and higher in 125 patients (125/162, 77.2%). H3K27me3-low expression significantly correlated with spine location (P < 0.001), conventional histological subtype (P < 0.001), and recurrence (P < 0.001). Log-rank test showed that H3K27me3-low expression was associated with poor RFS (P =0.027) and OS (P =0.009) in conventional chordoma patients. Cox multivariate analysis revealed that low expression of H3K27me3 was an independent predictor of poor OS (P =0.007) and RFS (P =0.025) in conventional chordoma patients.ConclusionsOur study indicates that low expression of H3K27me3 might be considered as a predictor for poor prognosis and recurrence, and it may provide a potential therapeutic target for conventional chordoma patients.

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Section: Discussionmentioning

confidence: 90%

Low expression of H3K27me3 is associated with poor prognosis in conventional chordoma

Wei

Yin³

et al. 2022

Front. Oncol.

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“…History of radiation therapy, dedifferentiated histological subtype, and the presence of metastasis were associated with poorer survival, and patients with pre-recurrence radiotherapy had the longest time to recurrence and mortality. 20 logical outcome following the resection of spinal chordomas. 20 Their findings showed that en bloc free-margin resection is preventive of recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…20 logical outcome following the resection of spinal chordomas. 20 Their findings showed that en bloc free-margin resection is preventive of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical markers predicting long-term recurrence following clival and spinal chordoma resection: a multicenter study

Ghaith

Akinduro

Alexander

et al. 2023

Neurosurgical Focus

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OBJECTIVE Chordomas are rare tumors from notochordal remnants and account for 1%–4% of all primary bone malignancies, often arising from the clivus and sacrum. Despite margin-negative resection and postoperative radiotherapy, chordomas often recur. Further, immunohistochemical (IHC) markers have not been assessed as predictive of chordoma recurrence. The authors aimed to identify the IHC markers that are predictive of postoperative long-term (≥ 1 year) chordoma recurrence by using trained multiple tree-based machine learning (ML) algorithms. METHODS The authors reviewed the records of patients who had undergone treatment for clival and spinal chordomas between January 2017 and June 2021 across the Mayo Clinic enterprise (Minnesota, Florida, and Arizona). Demographics, type of treatment, histopathology, and other relevant clinical factors were abstracted from each patient record. Decision tree and random forest classifiers were trained and tested to predict long-term recurrence based on unseen data using an 80/20 split. RESULTS One hundred fifty-one patients diagnosed and treated for chordomas were identified: 58 chordomas of the clivus, 48 chordomas of the mobile spine, and 45 chordomas sacrococcygeal in origin. Patients diagnosed with cervical chordomas were the oldest among all groups (58 ± 14 years, p = 0.009). Most patients were male (n = 91, 60.3%) and White (n = 139, 92.1%). Most patients underwent resection with or without radiation therapy (n = 129, 85.4%). Subtotal resection followed by radiation therapy (n = 51, 33.8%) was the most common treatment modality, followed by gross-total resection then radiation therapy (n = 43, 28.5%). Multivariate analysis showed that S100 and pan-cytokeratin are more likely to predict the increase in the risk of postoperative recurrence (OR 3.67, 95% CI 1.09–12.42, p= 0.03; and OR 3.74, 95% CI 0.05–2.21, p = 0.02, respectively). In the decision tree analysis, a clinical follow-up > 1897 days was found in 37% of encounters and a 90% chance of being classified for recurrence (accuracy = 77%). Random forest analysis (n = 500 trees) showed that patient age, type of surgical treatment, location of tumor, S100, pan-cytokeratin, and EMA are the factors predicting long-term recurrence. CONCLUSIONS The IHC and clinicopathological variables combined with tree-based ML tools successfully demonstrated a high capacity to identify recurrence patterns with an accuracy of 77%. S100, pan-cytokeratin, and EMA were the IHC drivers of recurrence. This shows the power of ML algorithms in analyzing and predicting outcomes of rare conditions of a small sample size.

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“…Given the relative scarcity of these tumors, most of the previous literature has combined primary and recurrent chordomas into a single cohort and included chordomas in all locations. 3,5–17 These studies demonstrated poor overall local recurrence-free survival and overall survival, but en bloc and gross total excision tend to improve survival rates. 3,4,6,17,18…”

mentioning

confidence: 99%

“…3,5–17 These studies demonstrated poor overall local recurrence-free survival and overall survival, but en bloc and gross total excision tend to improve survival rates. 3,4,6,17,18…”

mentioning

confidence: 99%

Outcomes of Recurrent Mobile Spine Chordomas

Kolz

Wellings

Houdek

et al. 2022

J Am Acad Orthop Surg

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Introduction: Chordomas of the mobile spine are rare malignant tumors. The purpose of this study was to review the outcomes of treatment for patients with recurrent mobile spine chordomas. Methods: The oncologic outcomes and survival of 30 patients undergoing treatment of a recurrent mobile spine chordoma were assessed over a 24-year period. The mean follow-up was 3.5 years. Results: In patients presenting with a recurrent mobile spine chordoma, the mean 2-and 5-year overall survival was 73% and 39%, respectively. Enneking appropriate resection trended toward improved overall survival at 5 years (100% vs. 32%, P = 0.24). Those undergoing surgical resection for recurrence had improved metastatic-free survival (hazard ratio 0.29, CI 0.08 to 0.99, P = 0.05). Positive margins were found to be a risk factor of further local recurrence (hazard ratio 7.92, CI 1.02 to 61.49, P = 0.04). Those undergoing nonsurgical management trended toward having an increase in new neurologic deficits (P = 0.09), however, there was no difference in overall complications based on treatment type (P = 0.13). Conclusion: Recurrent mobile spine chordoma portends a poor prognosis with an overall survival of less than 40% at 5 years. Surgical resection may help prevent new neurologic deficits and tumor metastasis while en bloc excision with negative surgical margins is associated with improved local recurrence-free survival. Chordomas are primary bone tumors most commonly presenting in the axial skeleton. The most common locations include the skull base, sacrum, and mobile spine (C1-L5). [1][2][3][4] These rare tumors are locally aggressive and have the capacity to metastasize leading to notable morbidity and mortality with either surgical or nonsurgical treatments. Given the relative scarcity of these tumors, most of the previous literature has combined primary and recurrent chordomas into a single cohort and included chordomas in all locations. 3,[5][6][7][8][9][10][11][12][13][14][15][16][17] These studies demonstrated poor overall local recurrence-free survival and overall survival, but en bloc and gross total excision tend to improve survival rates. 3,4,6,17,18 Our group previously reported the outcomes of a focused series of primary mobile spine chordomas treated surgically. 19 This study demonstrated the

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Results following surgical resection of recurrent chordoma of the spine: experience in a single institution

Cited by 6 publications

References 30 publications

Low expression of H3K27me3 is associated with poor prognosis in conventional chordoma

Low expression of H3K27me3 is associated with poor prognosis in conventional chordoma

Immunohistochemical markers predicting long-term recurrence following clival and spinal chordoma resection: a multicenter study

Outcomes of Recurrent Mobile Spine Chordomas

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