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Gross total resection and survival outcomes in elderly patients with spinal chordoma: a SEER-based analysis
John Pham1, Elias Shaaya1, Ben Rhee1
1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, United States.
Objective:
The association between aggressive resection and improved survival for adult spinal chordoma patients has not been well characterized in the geriatric population. Thus, the present study aimed to elucidate the relationship between gross total resection (GTR) and survival outcomes for patients across different age groups.
Methods:
The authors isolated all adult patients diagnosed with spinal chordoma from the 2000-2019 Surveillance, Epidemiology, and End Results database and divided patients into three surgical subgroups: no surgery, subtotal resection (STR), and GTR. Kaplan-Meier curves with a log-rank test were used to discern differences in overall survival (OS) between surgical subgroups. Univariate and multivariate analyses were used to identify prognostic factors of mortality.
Results:
There were 771 eligible patients: 227 (29.4%) received no surgery, 267 (34.6%) received STR, and 277 (35.9%) received GTR. Patients receiving no surgery had the lowest 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months). After stratifying patients by age, our multivariate analysis demonstrated that patients receiving GTR aged 40-59 (HR=0.26, CI=0.12-0.55, p<0.001), 60-79 (HR=0.51, CI=0.32-0.82, p=0.005), and 80-99 (HR=0.14, CI=0.05-0.37, p<0.001) had a lower risk of mortality compared to patients undergoing no surgery. The frequency of receiving GTR also decreased as a function of age (16.4% [80-99 years] vs. 43.2% [20-39 years]; p<0.001), but the frequency of receiving radiotherapy was comparable across all age groups (48.3% [80-99 years] vs. 45.5% [20-39 years]; p=0.762).
Conclusion:
GTR is associated with improved survival for middle-aged and elderly patients with spinal chordoma. Therefore, patients should not be excluded from aggressive resection on the basis of age alone. Rather, the decision to pursue surgery should be decided on an individual basis.
Insights
Aggressive resection (GTR) improves survival for spinal chordoma patients of all ages. Age alone should not preclude GTR, with decisions made individually.
Area of Science:
- Neurosurgery
- Oncology
- Geriatric Medicine
Background:
- Spinal chordoma survival is linked to aggressive resection, but this is poorly understood in older adults.
- Geriatric patients with spinal tumors present unique challenges for surgical intervention.
Purpose of the Study:
- To investigate the association between gross total resection (GTR) and survival outcomes in adult spinal chordoma patients across different age groups.
- To determine if age impacts the effectiveness of GTR for spinal chordoma.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019) for adult spinal chordoma patients.
- Categorized patients into no surgery, subtotal resection (STR), and GTR groups.
- Employed Kaplan-Meier curves, log-rank tests, and univariate/multivariate analyses to assess overall survival (OS) and mortality risk factors.
Main Results:
- Gross total resection (GTR) was associated with significantly lower mortality risk in patients aged 40-59, 60-79, and 80-99 compared to no surgery.
- Patients undergoing GTR showed improved 5-year OS (45.2%), 10-year OS (17.6%), and mean OS (72.1 months) compared to those with no surgery.
- The rate of GTR decreased with age, but radiotherapy rates were similar across age groups.
Conclusions:
- Gross total resection (GTR) significantly improves survival for middle-aged and elderly spinal chordoma patients.
- Age should not be the sole factor for excluding patients from aggressive surgical resection.
- Individualized patient assessment is crucial for surgical decision-making in spinal chordoma.
