Emanuele La Corte1,2, Morgan Broggi3, Alberto Raggi4, Silvia Schiavolin4, Francesco Acerbi3, Giovanni Danesi5, Mariangela Farinotti6, Giovanni Felisati7, Alberto Maccari7, Bianca Pollo8, Marco Saini3, Claudia Toppo4, Francesca Valvo9, Riccardo Ghidoni10,11, Maria Grazia Bruzzone12, Francesco DiMeco3, Paolo Ferroli3. 1. Molecular and Translational Medicine, Department of Health Sciences, University of Milan, Milan, Italy. emanuele.lacorte@unimi.it. 2. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy. emanuele.lacorte@unimi.it. 3. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy. 4. Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy. 5. Division of Ear, Nose, and Throat, and Skull Base Microsurgery, Ospedali Riuniti, Bergamo, Italy. 6. Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy. 7. Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy. 8. Neuropathology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy. 9. National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy. 10. Molecular and Translational Medicine, Department of Health Sciences, University of Milan, Milan, Italy. 11. Department of Health Sciences, Clinical Biochemistry and Mass Spectrometry Laboratory, University of Milan, Milan, Italy. 12. Neuroradiology Department, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy.
Abstract
BACKGROUND: Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients. METHODS: A retrospective review of all the patients diagnosed and treated for SBC at the Fondazione IRCCS Istituto Neurologico "Carlo Besta" between January 1992 and December 2017 has been performed. Survival analysis was performed and a logistic regression model was used. Statistically significant predictors were rated based on their log odds in order to preliminarily build a personalized grading scale-the Peri-Operative Chordoma Scale (POCS). RESULTS: Fifty-nine primary chordoma patients were included. The average follow-up from the first treatment was 82.6 months (95% CI, 65.5-99.7). POCS was built over PFS and MR contrast enhancement (intense vs mild/no, value 4), preoperative motor deficit (yes vs no, value 3), and the development of any postoperative complications (yes vs no, value 2). POCS ranges between 0 and 9, with higher scores being associated with reduced likelihood of survival and progression-free state. CONCLUSIONS: Our results show that preoperative clinical symptoms (motor deficits), surgical features (extent of tumor resection and surgeon's experience), development of postoperative complications, and KPS decline represent significant prognostic factors. The degree of MR contrast enhancement significantly correlated to both OS and PFS. We also preliminarily developed the POCS as a prognostic grading scale which may help neurosurgeons in the personalized management of patients undergoing potential adjuvant therapies.
BACKGROUND: Skull base chordomas (SBC) are rare malignant tumors and few factors have been found to be reliable markers for clinical decision making and survival prognostication. The aim of the present work was to identify specific prognostic factors potentially useful for the management of SBC patients. METHODS: A retrospective review of all the patients diagnosed and treated for SBC at the Fondazione IRCCS Istituto Neurologico "Carlo Besta" between January 1992 and December 2017 has been performed. Survival analysis was performed and a logistic regression model was used. Statistically significant predictors were rated based on their log odds in order to preliminarily build a personalized grading scale-the Peri-Operative Chordoma Scale (POCS). RESULTS: Fifty-nine primary chordomapatients were included. The average follow-up from the first treatment was 82.6 months (95% CI, 65.5-99.7). POCS was built over PFS and MR contrast enhancement (intense vs mild/no, value 4), preoperative motor deficit (yes vs no, value 3), and the development of any postoperative complications (yes vs no, value 2). POCS ranges between 0 and 9, with higher scores being associated with reduced likelihood of survival and progression-free state. CONCLUSIONS: Our results show that preoperative clinical symptoms (motor deficits), surgical features (extent of tumor resection and surgeon's experience), development of postoperative complications, and KPS decline represent significant prognostic factors. The degree of MR contrast enhancement significantly correlated to both OS and PFS. We also preliminarily developed the POCS as a prognostic grading scale which may help neurosurgeons in the personalized management of patients undergoing potential adjuvant therapies.
Entities:
Keywords:
Chordoma; Clivus; Complication; Endoscopic endonasal approach; Grading system; Outcome; Skull base; Skull base surgery
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