title: Prognostic significance of immunohistochemical expression of VEGFR2 and iNOS in spinal chordoma.
abstract: OBJECTIVE
  To clarify whether vascular endothelial growth factor receptor 2 (VEGFR2) and inducible nitric oxide synthase (iNOS) are involved in the angiogenesis and recurrence of spinal chordoma tissues and influence the overall survival.
  
  
  METHODS
  All patients affected by a spinal chordoma surgically treated between 1986 and 2007 were reviewed. We examined the expression of VEGFR2 and iNOS with immunohistochemistry using a tissue microarray containing 120 chordoma samples. Local recurrence and overall survival (OS) were analyzed.
  
  
  RESULTS
  A series of 40 chordoma patients who underwent surgery for a total of 120 lesions (including 80 recurrent lesions) were identified (sacrum 77.5 %, lumbar spine 17.5 %, cervical/thoracic spine 5 %). Surgical margins were wide in 30 (75 %), marginal in 8 (20 %) and intralesional in 2 (5 %) patients. Median follow-up was 120 months. The 5- and 10-year OS of the entire series of patients was 78.6 and 30 %, respectively. There were five primary chordomas (12.5 %) with moderate and 35 (87.5 %) with strong expression of VEGFR-2. All recurrent spinal chordomas displayed strong expression of VEGFR-2. The expression of iNOS was predominately moderate to high in primary chordomas: There were 15 tumors (37.5 %) with moderate and 25 tumors (62.5 %) with strong expression. All recurrent chordomas displayed strong expression of iNOS.
  
  
  CONCLUSIONS
  The high expression of VEGFR-2 and iNOS affected the OS. The OS at 10 years was only 30 %.
authors.affiliation: Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany, reza.akhavan-sigari@med.uni-goettingen.de.
authors.forename: Reza
authors.initials: R
authors.lastname: Akhavan-Sigari
authors.forename: Michael Robert
authors.initials: MR
authors.lastname: Gaab
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
authors.forename: Mehdi
authors.initials: M
authors.lastname: Abili
authors.forename: Helmut
authors.initials: H
authors.lastname: Ostertag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002817:Chordoma / Q000378:metabolism* / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism*; D011379:Prognosis; D013125:Spinal Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000601:surgery; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000378:metabolism*; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; C496319:NOS2 protein, human; D052247:Nitric Oxide Synthase Type II; C000588866:KDR protein, human; D040301:Vascular Endothelial Growth Factor Receptor-2