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The Clinical Outcomes of Cervical Spine Chordoma: A Nationwide Multicenter Retrospective Study
Hangeul Park1, Yunhee Choi2, Sungjoon Lee3
1Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
Objective:
Chordoma, a rare malignant tumor originating from embryonal notochord remnants, exhibits high resistance to conventional treatments, making surgical resection imperative. However, the factors influencing prognosis specifically for cervical spine chordoma have not been clearly identified. We investigate the prognosis of cervical spine chordoma with factors influential in a nationwide multicenter retrospective study.
Methods:
This study included all patients diagnosed with cervical spine chordoma at 7 tertiary referral centers from January 1998 to March 2023, excluding those with clivus and thoracic spine chordomas extending into the cervical spine. Local recurrence (LR) was identified through follow-up magnetic resonance imaging, either as reappearance in completely resected tumors or regrowth in residual tumors. The study assessed LR and overall survival, analyzing factors influencing LR and death.
Results:
Forty-five patients with cervical spine chordoma had a mean age of 46.4 years. Over a median follow-up of 52 months, LR and distant metastasis were observed in 21 (46.7%) and 4 patients (8.9%), respectively, and 16 patients (36%) were confirmed dead. The 5-year and 10-year cumulative LR rates were 51.3% and 60%, respectively, while the 5-year and 10-year survival rates were 82% and 53%. Age was the only significant factor affecting mortality (hazard ratio, 1.04; 95% confidence interval, 1.04-1.07; p=0.015). Notably, the degree of resection and adjuvant therapy did not statistically significantly impact local tumor control and mortality.
Conclusion:
This study, the largest multicenter retrospective analysis of cervical spine chordoma in Korea, identified age as the only factor significantly affecting patient survival.
Insights
Age is the primary factor influencing survival in cervical spine chordoma patients. This study found no significant impact of resection extent or adjuvant therapy on local tumor control or mortality.
Area of Science:
- Oncology
- Neurosurgery
- Spinal Tumors
Background:
- Chordoma is a rare, aggressive tumor arising from notochord remnants.
- Cervical spine chordomas are challenging due to their location and resistance to treatment.
- Prognostic factors for cervical spine chordoma require further elucidation.
Purpose of the Study:
- To investigate the prognosis of cervical spine chordoma.
- To identify factors influencing local recurrence (LR) and overall survival.
- To analyze outcomes in a nationwide multicenter retrospective study.
Main Methods:
- Retrospective analysis of 45 cervical spine chordoma patients from 7 centers (1998-2023).
- Exclusion of clival and extending thoracic chordomas.
- Assessment of LR via MRI, and analysis of LR and overall survival factors.
Main Results:
- Median follow-up was 52 months; 46.7% experienced LR, 8.9% distant metastasis, and 36% mortality.
- 5-year and 10-year LR rates were 51.3% and 60%, respectively.
- Age was the sole significant predictor of mortality (HR 1.04, p=0.015); resection extent and adjuvant therapy showed no significant impact.
Conclusions:
- Age is the only significant factor affecting survival in cervical spine chordoma.
- This study represents the largest Korean multicenter analysis of cervical spine chordoma.
- Further research may explore novel therapeutic strategies for this challenging tumor.
