Prognostic Factors in Surgical Patients with Chordomas of the Cervical Spine: A Study of 52 Cases from a Single Institution.

BACKGROUND: The recurrence rate of cervical chordomas is high, and hence it is important to discern the prognostic factors for local relapse and overall survival (OS).

METHODS: A retrospective review of 52 patients with cervical chordoma operated in our institution from January 1999 to March 2015 was performed. The association of clinicopathologic characteristics with local relapse-free survival (LRFS) and OS was analyzed. Univariate analysis was performed to determine whether tumor characteristics and types of therapy affected prognosis, and a multivariate Cox proportional hazard model was developed to further investigate local recurrence and mortality.

RESULTS: Mean follow-up time was 50 months. The cumulative 5- and 10-year LRFS was 35 and 0%, respectively, while the cumulative 5- and 10-year OS was 69 and 53%, respectively. The univariate analysis identified contiguous segments involved, intralesional surgical margin at primary surgery, primary surgery in local hospital, incisional biopsy, and without adjuvant radiotherapy as negative prognostic factors for LRFS, whereas for OS, only tumor location in the upper cervical spine was statistically significant. In the multivariate analysis, contiguous vertebral segments involved, intralesional surgical margins, and incisional biopsy were identified as negative prognostic factors for LRFS, whereas for OS, again only tumor location in the upper cervical spine was statistically significant.

CONCLUSIONS: Contiguous vertebral segments involved, intralesional surgical margin, without adjuvant radiotherapy, and incisional biopsy significantly increase local recurrence, while tumor location in the upper cervical spine significantly increases tumor-related mortality. Thus, computed tomography-guided fine-needle aspiration biopsy and total spondylectomy with marginal excision may improve survival of patients with cervical chordoma.