title: Surgical treatment of sacral chordoma: survival and prognostic factors.
abstract: BACKGROUND
  Sacral chordoma is a rare low-to-intermediate grade malignant tumour. The mainstay of treatment is still surgery with en bloc and wide resection margins, which can grant the best chances of a long-term control or cure of this disease. The first aim of this paper is to collect data about survival, time to local recurrence and metastasis among patients affected by sacral chordoma and primarily treated with surgery. The second aim is to analyze the influence of level resection, tumor volume and surgical margins on local recurrence.
  
  
  METHODS
  The study population was composed of 14 patients treated with sacral chordoma resection at the National Tumour Institute of Naples-Pascale (Italy) from January 2000 to June 2013. The median follow-up was 84 months (range 24-132 months). The follow-up was characterized by: standard radiographs, MRI, and a CT scan of the chest annually. Time to recurrence or metastasis was calculated from the date of resection to the date of diagnosis of first recurrence or metastasis.
  
  
  RESULTS
  Out of all the patients, six died (42.86 %) during the follow-up; 6 (42.86 %) had local recurrence; 4 (28.57 %) had metastasis. At univariate analysis wide surgical margins (R0) were associated with increased survival up to a local recurrence (OR = 0.0286; 95 % CI = 0.0014-0.5739; P = 0.026); the level of resection (OR = 3.33; 95 % CI = 0.3619-30.7025; P = 0.592) and tumour volume (P = 1) did not show a statistically significant correlation.
  
  
  CONCLUSIONS
  Based on our experience, we hope all patients to be treated by surgery, the only good standard treatment of this disease. The resection should result in margins as wide as possible. For these reasons, it is essential for this disease to be treated in highly specialized centres because only a complete surgery can offer a chance to care for these patients.
  
  
  CONCLUSIONS
  Solid survival at long-term follow-up can be achieved by a surgical resection performed with wide margins.
authors.affiliation: Orthopaedic Section, Public Health Department, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy. caruosi@unina.it.
authors.forename: C
authors.identifier: http://orcid.org/0000-0003-4537-085X
authors.initials: C
authors.lastname: Ruosi
authors.affiliation: Orthopaedic Section, Public Health Department, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Colella
authors.affiliation: Orthopaedic Section, Public Health Department, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
authors.forename: S L
authors.initials: SL
authors.lastname: Di Donato
authors.affiliation: Orthopaedic Section, Public Health Department, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Granata
authors.affiliation: Division of Skeletal Muscle Oncology Surgery, National Cancer Institute G. Pascale Foundation, IRCCS, Naples, Italy.
authors.forename: M G
authors.initials: MG
authors.lastname: Di Salvatore
authors.affiliation: Division of Skeletal Muscle Oncology Surgery, National Cancer Institute G. Pascale Foundation, IRCCS, Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fazioli
mesh_terms: D000368:Aged; D002817:Chordoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery*; D013125:Spinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Prognostic factor; Sacral chordoma; Surgical resection; Survival