Cervical chordomas: multicenter case series and meta-analysis

Oluwaseun O. Akinduro, Diogo P. Garcia, Ricardo A. Domingo, Tito Vivas-Buitrago, Bernardo Sousa-Pinto, Mohamad Bydon, Michelle J Clarke, Ziya L. Gokaslan, Maziyar A. Kalani, Kingsley Abode-Iyamah, Alfredo Quiñones-Hinojosa

Research output: Contribution to journalArticlepeer-review

Abstract

Background: En bloc spondylectomy is the gold standard for surgical resection of sacral chordomas (CHO), but the effect of extent of resection on recurrence and survival in patients with CHO of the cervical spine remains elusive. Methods: MEDLINE, Embase, Scopus, and Cochrane were systematically reviewed. Patients with cervical CHO treated at three tertiary-care academic institutions were reviewed for inclusion. We performed an individual participant data meta-analysis to assess the overall survival (OS) and progression free survival (PFS) after en bloc-gross total resection (GTR) and intralesional-GTR compared to subtotal resection (STR). We then performed an intention-to-treat analysis including all patients with attempted en bloc resection in the en bloc group, regardless of the surgical margins. Results: There was a total of 13 series including 161 patients with cervical CHO, including our current series of 22 patients. GTR (en bloc-GTR + intralesional-GTR) was associated with a significant decrease in the risk of local progression (pooled hazard ratio (PHR) = 0.22; 95% CI 0.08–0.59; p = 0.003) and risk of death (PHR 0.31; 95%; CI 0.12–0.83; p = 0.020). A meta-regression analyses determined that intralesional-GTR improved PFS (PHR 0.35; 95% CI 0.16–0.76; p = 0.009) as well as OS (PHR 0.25; 95% CI 0.08–0.79; p = 0.019) when compared to STR. En bloc-GTR was associated with a significant reduction in the risk of local progression (PHR 0.06; 95% CI 0.01–0.77; p = 0.030), but not a decreased OS (PHR 0.50; 95% CI 0.19–1.27; p = 0.145). Our intention-to-treat analyses revealed a near significant improvement in OS for the en bloc group (PHR: 0.15; 95% CI 0.02–1.22; p = 0.054), and nearly identical improvement in PFS. Radiation data was not available for the studies included in the meta-analysis. Conclusion: This is the first and only meta-analysis of patients with cervical CHO. We found that both en bloc-GTR and intralesional-GTR resulted in improved local tumor control when compared to STR.

Original languageEnglish (US)
JournalJournal of neuro-oncology
DOIs
StateAccepted/In press - 2021

Keywords

  • Cervical spine
  • Chordoma
  • En bloc spondylectomy
  • Gross total resection
  • Subtotal resection

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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