Risk factors for postoperative recurrence of sacral chordoma: an eleven-year single-centre retrospective study

Chordoma is a rare, low-grade malignant bone tumour that most commonly arises in the sacrococcygeal region. Reported prognostic factors for recurrence are inconsistent and the role of postoperative adjuvant treatment is undefined. We investigated risk factors for recurrence in a consecutive single-centre cohort of sacral chordoma in which R0 resection was achieved in every patient.

We retrospectively reviewed 34 consecutive patients with sacral chordoma treated with curative resection at our centre between 2013 and 2024. Clinical, surgical, adjuvant and follow-up data were recorded. Recurrence-free survival (RFS) was estimated using the Kaplan-Meier method, and independent risk factors for recurrence were identified using multivariate Cox regression.

The cohort comprised 24 men and ten women (mean age 62.1 years). Recurrence occurred in 19 of 34 patients (55.9%) after a median follow-up of 36 months; median RFS was 33 months (95% CI 16.7-49.3) and nine patients (47.4%) developed distant metastases. Maximum tumour diameter ≥ 65 mm (HR 3.42, 95% CI 1.18-9.92; p = 0.024) and a history of previous surgery (HR 4.57, 95% CI 1.52-13.73; p = 0.007) were independent risk factors for recurrence, whereas postoperative targeted therapy was associated with lower recurrence risk (HR 0.31, 95% CI 0.10-0.94; p = 0.038).

Recurrence of sacral chordoma was common even after R0 resection. Large tumour diameter and previous surgery were independent risk factors for recurrence. The association between postoperative targeted therapy and lower recurrence risk should be interpreted with caution because treatment was not randomised.