Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database

Ziya L. Gokaslan; Patricia L. Zadnik; Daniel M. Sciubba; Niccole Germscheid; C. Rory Goodwin; Jean Paul Wolinsky; Chetan Bettegowda; Mari L. Groves; Alessandro Luzzati; Laurence D. Rhines; Charles G. Fisher; Peter Pal Varga; Mark B. Dekutoski; Michelle J. Clarke; Michael G. Fehlings; Nasir A. Quraishi; Dean Chou; Jeremy J. Reynolds; Richard P. Williams; Norio Kawahara; Stefano Boriani

doi:10.3171/2015.7.SPINE15201

Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database

Ziya L. Gokaslan, Patricia L. Zadnik, Daniel M. Sciubba^*, Niccole Germscheid, C. Rory Goodwin, Jean Paul Wolinsky, Chetan Bettegowda, Mari L. Groves, Alessandro Luzzati, Laurence D. Rhines, Charles G. Fisher, Peter Pal Varga, Mark B. Dekutoski, Michelle J. Clarke, Michael G. Fehlings, Nasir A. Quraishi, Dean Chou, Jeremy J. Reynolds, Richard P. Williams, Norio KawaharaStefano Boriani

^*Corresponding author for this work

Neurological Surgery

Research output: Contribution to journal › Article › peer-review

89 Scopus citations

Abstract

OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

Original language	English (US)
Pages (from-to)	644-651
Number of pages	8
Journal	Journal of Neurosurgery: Spine
Volume	24
Issue number	4
DOIs	https://doi.org/10.3171/2015.7.SPINE15201
State	Published - Apr 2016

Funding

Dr. Rhines is a consultant for Stryker and Globus. Dr. Sciubba is a consultant for Medtronic and Depuy-Synthes. Dr. Fisher is a consultant for Medtronic and Nuvasive and receives non-studyrelated clinical or research support from OREF. Dr. Chou is a consultant for Globus, Medtronic, and Orthofix. Ms. Germscheid has a nonfinancial relationship with AOSpine International. Dr. Goodwin is a UNCF-Merck Science Initiative Postdoctoral Fellow and has received an award from the Burroughs Wellcome Fund. Dr. Dekutoski holds patents with the Mayo Office of International Property and receives clinical or research support from the AO Foundation. We are grateful to the collaborating centers' local clinical research personnel and support staff for their active participation. This study was organized and funded by AOSpine International through the AOSpine Knowledge Forum Tumor, a pathologyfocused working group of up to 10 international spine experts acting on behalf of AOSpine in their domains of scientific expertise. Study support was provided directly through AOSpine's research department and the AO Foundation's clinical investigation documentation unit.

Keywords

Chordoma
Enneking classification
Mobile spine
Oncology
Recurrence
Surgery
Survival
Tumor

ASJC Scopus subject areas

Surgery
Neurology
Clinical Neurology

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Gokaslan, Z. L., Zadnik, P. L., Sciubba, D. M., Germscheid, N., Goodwin, C. R., Wolinsky, J. P., Bettegowda, C., Groves, M. L., Luzzati, A., Rhines, L. D., Fisher, C. G., Varga, P. P., Dekutoski, M. B., Clarke, M. J., Fehlings, M. G., Quraishi, N. A., Chou, D., Reynolds, J. J., Williams, R. P., ... Boriani, S. (2016). Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database. Journal of Neurosurgery: Spine, 24(4), 644-651. https://doi.org/10.3171/2015.7.SPINE15201

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title = "Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database",

abstract = "OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.",

keywords = "Chordoma, Enneking classification, Mobile spine, Oncology, Recurrence, Surgery, Survival, Tumor",

author = "Gokaslan, {Ziya L.} and Zadnik, {Patricia L.} and Sciubba, {Daniel M.} and Niccole Germscheid and Goodwin, {C. Rory} and Wolinsky, {Jean Paul} and Chetan Bettegowda and Groves, {Mari L.} and Alessandro Luzzati and Rhines, {Laurence D.} and Fisher, {Charles G.} and Varga, {Peter Pal} and Dekutoski, {Mark B.} and Clarke, {Michelle J.} and Fehlings, {Michael G.} and Quraishi, {Nasir A.} and Dean Chou and Reynolds, {Jeremy J.} and Williams, {Richard P.} and Norio Kawahara and Stefano Boriani",

note = "Publisher Copyright: {\textcopyright}AANS, 2016.",

year = "2016",

month = apr,

doi = "10.3171/2015.7.SPINE15201",

language = "English (US)",

volume = "24",

pages = "644--651",

journal = "Journal of Neurosurgery: Spine",

issn = "1547-5654",

publisher = "American Association of Neurological Surgeons",

number = "4",

}

Gokaslan, ZL, Zadnik, PL, Sciubba, DM, Germscheid, N, Goodwin, CR, Wolinsky, JP, Bettegowda, C, Groves, ML, Luzzati, A, Rhines, LD, Fisher, CG, Varga, PP, Dekutoski, MB, Clarke, MJ, Fehlings, MG, Quraishi, NA, Chou, D, Reynolds, JJ, Williams, RP, Kawahara, N & Boriani, S 2016, 'Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database', Journal of Neurosurgery: Spine, vol. 24, no. 4, pp. 644-651. https://doi.org/10.3171/2015.7.SPINE15201

TY - JOUR

T1 - Mobile spine chordoma

T2 - Results of 166 patients from the AOSpine Knowledge Forum Tumor database

AU - Gokaslan, Ziya L.

AU - Zadnik, Patricia L.

AU - Sciubba, Daniel M.

AU - Germscheid, Niccole

AU - Goodwin, C. Rory

AU - Wolinsky, Jean Paul

AU - Bettegowda, Chetan

AU - Groves, Mari L.

AU - Luzzati, Alessandro

AU - Rhines, Laurence D.

AU - Fisher, Charles G.

AU - Varga, Peter Pal

AU - Dekutoski, Mark B.

AU - Clarke, Michelle J.

AU - Fehlings, Michael G.

AU - Quraishi, Nasir A.

AU - Chou, Dean

AU - Reynolds, Jeremy J.

AU - Williams, Richard P.

AU - Kawahara, Norio

AU - Boriani, Stefano

PY - 2016/4

Y1 - 2016/4

N2 - OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

AB - OBJECT: A chordoma is an indolent primary spinal tumor that has devastating effects on the patient's life. These lesions are chemoresistant, resistant to conventional radiotherapy, and moderately sensitive to proton therapy; however, en bloc resection remains the preferred treatment for optimizing patient outcomes. While multiple small and largely retrospective studies have investigated the outcomes following en bloc resection of chordomas in the sacrum, there have been few large-scale studies on patients with chordomas of the mobile spine. The goal of this study was to review the outcomes of surgically treated patients with mobile spine chordomas at multiple international centers with respect to local recurrence and survival. This multiinstitutional retrospective study collected data between 1988 and 2012 about prognosispredicting factors, including various clinical characteristics and surgical techniques for mobile spine chordoma. Tumors were classified according to the Enneking principles and analyzed in 2 treatment cohorts: Enneking-appropriate (EA) and Enneking-inappropriate (EI) cohorts. Patients were categorized as EA when the final pathological assessment of the margin matched the Enneking recommendation; otherwise, they were categorized as EI. METHODS: Descriptive statistics were used to summarize the data (Student t-test, chi-square, and Fisher exact tests). Recurrence and survival data were analyzed using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazard modeling. RESULTS: A total of 166 patients (55 female and 111 male patients) with mobile spine chordoma were included. The median patient follow-up was 2.6 years (range 1 day to 22.5 years). Fifty-eight (41%) patients were EA and 84 (59%) patients were EI. The type of biopsy (p < 0.001), spinal location (p = 0.018), and if the patient received adjuvant therapy (p < 0.001) were significantly different between the 2 cohorts. Overall, 58 (35%) patients developed local recurrence and 57 (34%) patients died. Median survival was 7.0 years postoperative: 8.4 years postoperative for EA patients and 6.4 years postoperative for EI patients (p = 0.023). The multivariate analysis showed that the EI cohort was significantly associated with an increased risk of local recurrence in comparison with the EA cohort (HR 7.02; 95% CI 2.96-16.6; p < 0.001), although no significant difference in survival was observed. CONCLUSIONS: EA resection plays a major role in decreasing the risk for local recurrence in patients with chordoma of the mobile spine.

KW - Chordoma

KW - Enneking classification

KW - Mobile spine

KW - Oncology

KW - Recurrence

KW - Surgery

KW - Survival

KW - Tumor

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Mobile spine chordoma: Results of 166 patients from the AOSpine Knowledge Forum Tumor database

Abstract

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