title: Surgical treatment of sacral chordoma: prognostic variables for local recurrence and overall survival.
abstract: OBJECTIVE
  Sacral chordomas (SC) are rare, locally invasive, malignant neoplasms. Despite surgical resection and adjuvant therapies, local recurrence (LR) is common and overall survival (OS) is poor. The objective of this study was to identify prognostic factors that have an impact on the local recurrence-free survival (LRFS) and OS of patients with SC.
  
  
  METHODS
  Utilizing the AOSpine Knowledge Forum Tumor multicenter ambispective database, surgically treated SC cases were identified. Cox regression modeling was used to assess the effect of several clinically relevant variables on OS and LRFS.
  
  
  RESULTS
  A total of 167 patients with surgically treated SC were identified. The male/female ratio was 98/69 with a mean age of 57 ± 15 years at the time of surgery. The LR was 35% (n = 57), death occurred in 30% of patients (n = 50) during the study period. The median OS was 6 years post-surgery and LRFS was 4 years. In the univariate analysis, previous tumor surgery at the same site (P = 0.002), intralesional resection (P < 0.001), and larger tumor volume (P = 0.030) were significantly associated with LR. Increasing age (P < 0.001) and a preoperative motor deficit of C or D (P = 0.003) were significantly associated with poor OS, and nerve root sacrifice showed a trend towards significance (P = 0.088). In the multivariate models, previous surgery and intralesional resection were significantly related to LR, while increasing age and motor deficit of C or D were associated with poor OS.
  
  
  CONCLUSIONS
  This study identified two predictive variables for LRFS (previous tumor surgery and type of surgical resection) and two for OS (age and impaired motor function) in surgically treated SC patients. Our results indicate that en bloc resection reduces LR but does not influence OS. However, this was likely due to short follow-up (3.2 years).
authors.affiliation: National Center for Spinal Disorders, Kiralyhagó Street 1-3, 1126, Budapest, Hungary, vpp@bhc.hu.
authors.forename: Péter Pál
authors.initials: PP
authors.lastname: Varga
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Szövérfi
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.forename: Stefano
authors.initials: S
authors.lastname: Boriani
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Mark B
authors.initials: MB
authors.lastname: Dekutoski
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.forename: Nasir A
authors.initials: NA
authors.lastname: Quraishi
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Reynolds
authors.forename: Alessandro
authors.initials: A
authors.lastname: Luzzati
authors.forename: Richard
authors.initials: R
authors.lastname: Williams
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Niccole M
authors.initials: NM
authors.lastname: Germscheid
authors.forename: Aron
authors.initials: A
authors.lastname: Lazary
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002817:Chordoma / Q000401:mortality* / Q000601:surgery*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068079:Motor Disorders / Q000150:complications; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality* / Q000601:surgery*; D055815:Young Adult