BACKGROUND CONTEXT: Although several authors have already reported on the high local recurrence rate of sacral chordomas after surgical resection, there are no reports on the risk factors for recurrence after resection when combined with preoperative tumor-related blood vessel embolism by digital subtraction angiography (DSA) technique. PURPOSE: To investigate the factors related to the continuous disease-free survival time (CDFS) after the resection of sacral chordomas combined with embolization. STUDY DESIGN/ SETTING: Retrospective review of the signs, images, and immunohistochemical data of patients with sacral chordomas treated with an initial operation combined with transcatheter arterial embolization. PATIENT SAMPLE: Twenty-two patients with sacral chordomas received initial resection combined with transcatheter arterial embolization. OUTCOME MEASURES: Recurrence, proliferating cell nuclear antigen (PCNA) expression, basic fibroblast growth factor (bFGF) expression, CDFS. METHODS: All cases were selected and followed for an average of 39.2 months. The roles of gender, age, tumor size, tumor location, surgical method, radiation therapy, PCNA expression, and bFGF expression in local recurrence were analyzed using the log-rank test. RESULTS: Sacral chordomas recurred in eight of 22 cases. The CDFS was significantly greater in tumors located below S3 as compared with those above S3. When evaluating PCNA and bFGF expression levels, the CDFS was greater in low expressions rather than high expressions. It was determined that the surgical method used was of prognostic significance to the CDFS. CONCLUSIONS: Higher tumor location and higher expressions of PCNA and bFGF will lead to a shorter CDFS. Resecting the tumor as completely as possible will decrease the chances of local recurrence of sacral chordomas.
BACKGROUND CONTEXT: Although several authors have already reported on the high local recurrence rate of sacral chordomas after surgical resection, there are no reports on the risk factors for recurrence after resection when combined with preoperative tumor-related blood vessel embolism by digital subtraction angiography (DSA) technique. PURPOSE: To investigate the factors related to the continuous disease-free survival time (CDFS) after the resection of sacral chordomas combined with embolization. STUDY DESIGN/ SETTING: Retrospective review of the signs, images, and immunohistochemical data of patients with sacral chordomas treated with an initial operation combined with transcatheter arterial embolization. PATIENT SAMPLE: Twenty-two patients with sacral chordomas received initial resection combined with transcatheter arterial embolization. OUTCOME MEASURES: Recurrence, proliferating cell nuclear antigen (PCNA) expression, basic fibroblast growth factor (bFGF) expression, CDFS. METHODS: All cases were selected and followed for an average of 39.2 months. The roles of gender, age, tumor size, tumor location, surgical method, radiation therapy, PCNA expression, and bFGF expression in local recurrence were analyzed using the log-rank test. RESULTS:Sacral chordomas recurred in eight of 22 cases. The CDFS was significantly greater in tumors located below S3 as compared with those above S3. When evaluating PCNA and bFGF expression levels, the CDFS was greater in low expressions rather than high expressions. It was determined that the surgical method used was of prognostic significance to the CDFS. CONCLUSIONS: Higher tumor location and higher expressions of PCNA and bFGF will lead to a shorter CDFS. Resecting the tumor as completely as possible will decrease the chances of local recurrence of sacral chordomas.
Authors: Carmine Zoccali; Jesse Skoch; Apar S Patel; Christina M Walter; Philip Maykowski; Ali A Baaj Journal: Eur Spine J Date: 2016-02-25 Impact factor: 3.134