Perez-Vega Carlos, Akinduro Oluwaseun O, Ruiz-Garcia Henry J, Ghaith Abdul Karim A, Almeida Joao P, Jentoft Mark E, Mahajan Anita, Janus Jeffrey R, Bendok Bernard R, Choby Garret W, Middlebrooks Erik H, Trifiletti Daniel M, Chaichana Kaisorn L, Laack Nadia N, Quinones-Hinojosa Alfredo, Van Gompel Jamie J
Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
World Neurosurg. 2024 Jan;181:e620-e627. doi: 10.1016/j.wneu.2023.10.101. Epub 2023 Oct 28.
Skull-base chordomas are aggressive tumors with a propensity for recurrence/progression. Even with standard of care (SoC), 5-year recurrence rates are variable (19%-54%). This high recurrence/progression rate correlates with increased morbidity and mortality. We sought to analyze a multicenter cohort of skull base chordomas to identify predictors of progression in patients receiving SoC.
The [Blinded]-Neurosurgery data registry was queried for skull base chordomas treated from 2008-2020. Patients with the histopathologic diagnosis of chordoma were included. The cohort was composed of patients with preoperative and postoperative magnetic resonance imaging. Tumor volume and radiologic characteristics were obtained from axial T2 sequences using a Digital Imaging and Communications in Medicine viewer. Survival analysis was performed using Kaplan-Meier method, and time-to-event multivariate regression was performed to identify independent predictors of progression.
The cohort included 195 patients, of which 66 patients met inclusion criteria; median age was 44, and 28 (42%) were females. Fifty-four (82%) received SoC, 7 (11%) resection only, and 5 (8%) radiotherapy only. Median preoperative and postoperative tumor volumes were 11.55 cm (0.33-54.89) and 0.34 cm (0-42.52), respectively. Recurrence rate with SoC was 37%. Postoperative tumor volume (P = 0.010) correlated with progression. A postoperative volume of >4.9 cm (P = 0.044), ≤81.3% of tumor resection (P = 0.02), and lower-clivus location (P < 0.005) correlated with decreased time to progression.
Skull base chordomas can be challenging to resect. Even though maximal resection and radiotherapy improve rate of tumor progression, many of these lesions eventually recur. We have identified a postoperative tumor volume of ≥4.9 cm and extent of resection of ≤81.3% in this cohort as predictors of progression in patients receiving SoC.
颅底脊索瘤是侵袭性肿瘤，有复发/进展倾向。即便采用标准治疗方案（SoC），5年复发率也各不相同（19%-54%）。这种高复发/进展率与发病率和死亡率增加相关。我们试图分析一组多中心颅底脊索瘤患者，以确定接受SoC治疗患者的进展预测因素。
查询[盲法]-神经外科数据登记处2008年至2020年治疗的颅底脊索瘤患者。纳入经组织病理学诊断为脊索瘤的患者。该队列由术前行磁共振成像和术后行磁共振成像的患者组成。使用医学数字成像和通信阅读器从轴向T2序列获取肿瘤体积和放射学特征。采用Kaplan-Meier方法进行生存分析，并进行事件发生时间多变量回归分析以确定进展的独立预测因素。
该队列包括195例患者，其中66例符合纳入标准；中位年龄为44岁，28例（42%）为女性。54例（82%）接受SoC治疗，7例（11%）仅行切除术，5例（8%）仅行放射治疗。术前和术后肿瘤体积中位数分别为11.55 cm（0.33-54.89）和0.34 cm（0-42.52）。SoC治疗后的复发率为37%。术后肿瘤体积（P = 0.010）与进展相关。术后体积>4.9 cm（P = 0.044）、肿瘤切除率≤81.3%（P = 0.02）以及斜坡下部位置（P < 0.005）与进展时间缩短相关。
颅底脊索瘤的切除可能具有挑战性。尽管最大程度切除和放射治疗可提高肿瘤进展率，但许多这些病变最终仍会复发。我们已确定该队列中术后肿瘤体积≥4.9 cm和切除范围≤81.3%是接受SoC治疗患者进展的预测因素。
