• Jianhua Zhou, James Sun, Harrison Xiao Bai, Xiangyan Huang, Yingjie Zou, Xia Tan, Zishu Zhang, Xiangqi Tang, Yongguang Tao, Bo Xiao, Paul J Zhang, and Li Yang.
• Department of Pathology, First Xiangya Hospital, Central South University, Changsha, Hunan, China.
• Neurosurgery. 2017 Nov 1; 81 (5): 812-823.

BackgroundThe low incidence of spinal chordoma precludes a prospective study of prognostic factors with a large patient cohort.ObjectiveTo perform a comprehensive integrative analysis on the prognostic factors, treatment, and outcomes of patients with spinal chordoma using data from 2 institutions and the literature.MethodsAppropriate studies were identified per search criteria. The local database was retrospectively searched to include a similar patient cohort.ResultsOverall, 108 studies from the literature and 30 patients from our local institution were identified, resulting in a total of 682 patients. The median age was 57 years old and 35.2% were female. The median follow-up was 46 months (range: 1-408). The median progression-free survival (PFS) and overall survival (OS) were 72 months and 115 months, respectively. Significant prognostic factors for PFS on multivariate analysis included age (pediatric vs adult, hazard ratio [HR]: 2.00-14.36), tumor location (mobile spine vs sacral spine, HR: 0.31-0.87), pathology (differentiated vs classic, HR: 2.48-10.90),and chemotherapy (HR:1.11-3.85). Significant prognostic factors for OS on multivariate analysis included age (geriatric vs adult, HR: 1.52-3.45 and pediatric vs adult, HR: 1.73-9.36), bladder or bowel dysfunction (HR: 1.27-5.43), pathology (dedifferentiated vs classic, HR: 2.38-11.09), recurrence or progression (HR: 1.72-4.48), and metastases (HR: 1.11-2.47).ConclusionIn patients with spinal chordoma, young age, location in sacral spine, dedifferentiated pathology, and chemotherapy were negative predictors of PFS, while young and old age, bladder or bowel dysfunction at presentation, dedifferentiated pathology, recurrence or progression, and metastases portended a worse OS.Copyright © 2017 by the Congress of Neurological Surgeons

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