Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database

Ziya L. Gokaslan, Patricia L. Zadnik, Daniel M. Sciubba, Niccole Germscheid, C. Rory Goodwin, Jean Paul Wolinsky, Chetan Bettegowda, Mari L. Groves, Alessandro Luzzati, Laurence D. Rhines, Charles G. Fisher, Peter Pal Varga, Mark B. Dekutoski, Michelle J. Clarke, Michael G. Fehlings, Nasir A. Quraishi, Dean Chou, Jeremy J. Reynolds, Richard P. Williams, Norio KawaharaStefano Boriani

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

Original languageEnglish (US)
Pages (from-to)644-651
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Chordoma
Spine
Databases
Neoplasms
Recurrence
Survival
Retrospective Studies
Proton Therapy
Sacrum
Kaplan-Meier Estimate

Keywords

  • Chordoma
  • Enneking classification
  • Mobile spine
  • Oncology
  • Recurrence
  • Surgery
  • Survival
  • Tumor

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gokaslan, Z. L., Zadnik, P. L., Sciubba, D. M., Germscheid, N., Goodwin, C. R., Wolinsky, J. P., ... Boriani, S. (2016). Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database. Journal of Neurosurgery: Spine, 24(4), 644-651. https://doi.org/10.3171/2015.7.SPINE15201

Mobile spine chordoma : Results of 166 patients from the AOSpine Knowledge Forum Tumor database. / Gokaslan, Ziya L.; Zadnik, Patricia L.; Sciubba, Daniel M.; Germscheid, Niccole; Goodwin, C. Rory; Wolinsky, Jean Paul; Bettegowda, Chetan; Groves, Mari L.; Luzzati, Alessandro; Rhines, Laurence D.; Fisher, Charles G.; Varga, Peter Pal; Dekutoski, Mark B.; Clarke, Michelle J.; Fehlings, Michael G.; Quraishi, Nasir A.; Chou, Dean; Reynolds, Jeremy J.; Williams, Richard P.; Kawahara, Norio; Boriani, Stefano.

In: Journal of Neurosurgery: Spine, Vol. 24, No. 4, 01.04.2016, p. 644-651.

Research output: Contribution to journalArticle

Gokaslan, ZL, Zadnik, PL, Sciubba, DM, Germscheid, N, Goodwin, CR, Wolinsky, JP, Bettegowda, C, Groves, ML, Luzzati, A, Rhines, LD, Fisher, CG, Varga, PP, Dekutoski, MB, Clarke, MJ, Fehlings, MG, Quraishi, NA, Chou, D, Reynolds, JJ, Williams, RP, Kawahara, N & Boriani, S 2016, 'Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database', Journal of Neurosurgery: Spine, vol. 24, no. 4, pp. 644-651. https://doi.org/10.3171/2015.7.SPINE15201
Gokaslan ZL, Zadnik PL, Sciubba DM, Germscheid N, Goodwin CR, Wolinsky JP et al. Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database. Journal of Neurosurgery: Spine. 2016 Apr 1;24(4):644-651. https://doi.org/10.3171/2015.7.SPINE15201
Gokaslan, Ziya L. ; Zadnik, Patricia L. ; Sciubba, Daniel M. ; Germscheid, Niccole ; Goodwin, C. Rory ; Wolinsky, Jean Paul ; Bettegowda, Chetan ; Groves, Mari L. ; Luzzati, Alessandro ; Rhines, Laurence D. ; Fisher, Charles G. ; Varga, Peter Pal ; Dekutoski, Mark B. ; Clarke, Michelle J. ; Fehlings, Michael G. ; Quraishi, Nasir A. ; Chou, Dean ; Reynolds, Jeremy J. ; Williams, Richard P. ; Kawahara, Norio ; Boriani, Stefano. / Mobile spine chordoma : Results of 166 patients from the AOSpine Knowledge Forum Tumor database. In: Journal of Neurosurgery: Spine. 2016 ; Vol. 24, No. 4. pp. 644-651.
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abstract = "OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41{\%}) patients were EA and 84 (59{\%}) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35{\%}) patients developed local recurrence and 57 (34{\%}) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95{\%} CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.",
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T1 - Mobile spine chordoma

T2 - Results of 166 patients from the AOSpine Knowledge Forum Tumor database

AU - Gokaslan, Ziya L.

AU - Zadnik, Patricia L.

AU - Sciubba, Daniel M.

AU - Germscheid, Niccole

AU - Goodwin, C. Rory

AU - Wolinsky, Jean Paul

AU - Bettegowda, Chetan

AU - Groves, Mari L.

AU - Luzzati, Alessandro

AU - Rhines, Laurence D.

AU - Fisher, Charles G.

AU - Varga, Peter Pal

AU - Dekutoski, Mark B.

AU - Clarke, Michelle J.

AU - Fehlings, Michael G.

AU - Quraishi, Nasir A.

AU - Chou, Dean

AU - Reynolds, Jeremy J.

AU - Williams, Richard P.

AU - Kawahara, Norio

AU - Boriani, Stefano

PY - 2016/4/1

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N2 - OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

AB - OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

KW - Chordoma

KW - Enneking classification

KW - Mobile spine

KW - Oncology

KW - Recurrence

KW - Surgery

KW - Survival

KW - Tumor

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