title: Prognostic Factors in Patients With Spinal Chordoma: An Integrative Analysis of 682 Patients.
abstract: BACKGROUND
  The low incidence of spinal chordoma precludes a prospective study of prognostic factors with a large patient cohort.
  
  
  OBJECTIVE
  To perform a comprehensive integrative analysis on the prognostic factors, treatment, and outcomes of patients with spinal chordoma using data from 2 institutions and the literature.
  
  
  METHODS
  Appropriate studies were identified per search criteria. The local database was retrospectively searched to include a similar patient cohort.
  
  
  RESULTS
  Overall, 108 studies from the literature and 30 patients from our local institution were identified, resulting in a total of 682 patients. The median age was 57 years old and 35.2% were female. The median follow-up was 46 months (range: 1-408). The median progression-free survival (PFS) and overall survival (OS) were 72 months and 115 months, respectively. Significant prognostic factors for PFS on multivariate analysis included age (pediatric vs adult, hazard ratio [HR]: 2.00-14.36), tumor location (mobile spine vs sacral spine, HR: 0.31-0.87), pathology (differentiated vs classic, HR: 2.48-10.90),and chemotherapy (HR:1.11-3.85). Significant prognostic factors for OS on multivariate analysis included age (geriatric vs adult, HR: 1.52-3.45 and pediatric vs adult, HR: 1.73-9.36), bladder or bowel dysfunction (HR: 1.27-5.43), pathology (dedifferentiated vs classic, HR: 2.38-11.09), recurrence or progression (HR: 1.72-4.48), and metastases (HR: 1.11-2.47).
  
  
  CONCLUSIONS
  In patients with spinal chordoma, young age, location in sacral spine, dedifferentiated pathology, and chemotherapy were negative predictors of PFS, while young and old age, bladder or bowel dysfunction at presentation, dedifferentiated pathology, recurrence or progression, and metastases portended a worse OS.
authors.affiliation: Department of Pathology, First Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Harrison Xiao
authors.initials: HX
authors.lastname: Bai
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xiangyan
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Yingjie
authors.initials: Y
authors.lastname: Zou
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Zishu
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Xiangqi
authors.initials: X
authors.lastname: Tang
authors.affiliation: Cancer Research Institute of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
authors.forename: Yongguang
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Xiao
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Zhang
authors.affiliation: Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D002817:Chordoma / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013125:Spinal Neoplasms / Q000401:mortality*; D013131:Spine / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis
keywords: Chordoma; Prognostic factors; Spine; Treatment