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Analysis of the Infiltrative Features of Chordoma: The Relationship Between Micro-Skip Metastasis and Postoperative Outcomes

Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Chordomas are very rare primary malignant bone tumors that arise commonly from the sacrum (50–60%) and clivus (25–35%). Chordomas have a high rate of recurrence. The authors confirmed a unique histologic infiltration pattern of chordomas that resembles a skip-metastatic lesion in normal tissue around tumor, which they named “micro-skip metastasis.” This study aimed to examine the correlations between the clinicopathologic features of chordomas, including micro-skip metastasis, and the clinical outcomes, including overall survival, local recurrence-free survival, and distant metastasis-free survival.

Methods

The study analyzed histopathologic and clinical data from patients with sacral chordomas who underwent en bloc resection from July 1991 through July 2014. Cases with a minimum follow-up period shorter than 20 months after resection were excluded. Kaplan–Meier survival analyses with log-rank tests were performed for overall survival, metastasis-free survival, and recurrence-free survival.

Results

The study retrospectively reviewed 40 patients. The mean follow-up period was 98.2 months (range 22–297 months). The local recurrence rate was 41.3%. Micro-skip metastases, observed in 17 patients (42.5%), were associated with a significantly increased risk of local recurrence (p = 0.023) but not with overall survival or distant metastasis-free survival. Poorer overall survival was associated with histologic vascular invasion (p = 0.030) and a greater maximum tumor diameter (p = 0.050).

Conclusions

The presence of micro-skip metastasis was associated with a higher rate of local recurrence. The maximum tumor diameter and the presence of histologic vascular invasion were associated with poorer overall survival.

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References

  1. Stacchiotti S, Casali PG, Lo Vullo S, et al. Chordoma of the mobile spine and sacrum: a retrospective analysis of a series of patients surgically treated at two referral centers. Ann Surg Oncol. 2010;17:211–19.

    Article  PubMed  Google Scholar 

  2. Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ. Chordoma: current concepts, management, and future directions. Lancet Oncol. 2012;13:e69–76.

    Article  PubMed  Google Scholar 

  3. Hanna SA, Aston WJ, Briggs TW, Cannon SR, Saifuddin A. Sacral chordoma: can local recurrence after sacrectomy be predicted? Clin Orthop Relat Res. 2008;466:2217–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kayani B, Sewell MD, Tan KA, et al. Prognostic factors in the operative management of sacral chordomas. World Neurosurg. 2015;84:1354–61.

    Article  PubMed  Google Scholar 

  5. Yonemoto T, Tatezaki S, Takenouchi T, Ishii T, Satoh T, Moriya H. The surgical management of sacrococcygeal chordoma. Cancer. 1999;85:878–83.

    Article  CAS  PubMed  Google Scholar 

  6. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–20.

    Google Scholar 

  7. Yamaguchi T, Iwata J, Sugihara S, et al. Distinguishing benign notochordal cell tumors from vertebral chordoma. Skeletal Radiol. 2008;37:291–99.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ruggieri P, Angelini A, Ussia G, Montalti M, Mercuri M. Surgical margins and local control in resection of sacral chordomas. Clin Orthop Relat Res. 2010;468:2939–47.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Schwab JH, Healey JH, Rose P, Casas-Ganem J, Boland PJ. The surgical management of sacral chordomas. Spine. 2009;34:2700–04.

    Article  PubMed  Google Scholar 

  10. Hulen CA, Temple HT, Fox WP, Sama AA, Green BA, Eismont FJ. Oncologic and functional outcome following sacrectomy for sacral chordoma. J Bone Joint Surg Am. 2006;88:1532–39.

    Article  PubMed  Google Scholar 

  11. Dubory A, Missenard G, Lambert B, Court C. “En bloc’’ resection of sacral chordomas by combined anterior and posterior surgical approach: a monocentric retrospective review about 29 cases. Eur Spine J. 2014;23:1940–48.

    Article  PubMed  Google Scholar 

  12. Kawaguchi N, Ahmed AR, Matsumoto S, Manabe J, Matsushita Y. The concept of curative margin in surgery for bone and soft tissue sarcoma. Clin Orthop Relat Res. 2004;419:165–72.

    Article  Google Scholar 

  13. Lewis JJ, Leung D, Casper ES, Woodruff J, Hajdu SI, Brennan MF. Multifactorial analysis of long-term follow-up (more than 5 years) of primary extremity sarcoma. Arch Surg. 1999;134:190–94.

    Article  CAS  PubMed  Google Scholar 

  14. Pisters PW, Pollock RE. Staging and prognostic factors in soft tissue sarcoma. Semin Radiat Oncol. 1999;9:307–14.

    Article  CAS  PubMed  Google Scholar 

  15. Stojadinovic A, Leung DH, Hoos A, Jaques DP, Lewis JJ, Brennan MF. Analysis of the prognostic significance of microscopic margins in 2084 localized primary adult soft tissue sarcomas. Ann Surg. 2002;235:424–34.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cao J, Hu JL, Chen C, et al. Vascular invasion is an independent prognostic factor for distant recurrence-free survival in papillary thyroid carcinoma: a matched-case comparative study. J Clin Pathol. 2016;69:872–77.

    Article  CAS  PubMed  Google Scholar 

  17. Wang H, Li P, Zhang X, Xia Z, Lu Y, Huang H. Histological vascular invasion is a novel prognostic indicator in extranodal natural killer/T cell lymphoma, nasal type. Oncol Lett. 2016;12:825–36.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Setälä LP, Kosma VM, Marin S, et al. Prognostic factors in gastric cancer: the value of vascular invasion, mitotic rate, and lymphoplasmacytic infiltration. Br J Cancer. 1996;74:766–72.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Slaton JW, Morgenstern N, Levy DA, et al. Tumor stage, vascular invasion and the percentage of poorly differentiated cancer: independent prognosticators for inguinal lymph node metastasis in penile squamous cancer. J Urol. 2001;165:1138–42.

    Article  CAS  PubMed  Google Scholar 

  20. Yonemoto T, Tatezaki S, Ishii T, Iwata S, Takeuchi Y, Araki A. Histological vascular invasion by tumors is a risk factor for distant metastasis in malignant fibrous histiocytoma. Anticancer Res. 2005;25:1337–42.

    PubMed  Google Scholar 

  21. Carneiro A, Bendahl PO, Engellau J, et al. A prognostic model for soft tissue sarcoma of the extremities and trunk wall based on size, vascular invasion, necrosis, and growth pattern. Cancer. 2011;117:1279–87.

    Article  PubMed  Google Scholar 

  22. de Silva MV, McMahon AD, Paterson L, Reid R. Identification of poorly differentiated synovial sarcoma: a comparison of clinicopathological and cytogenetic features with those of typical synovial sarcoma. Histopathology. 2003;43:220–30.

    Article  PubMed  Google Scholar 

  23. Hsieh PC, Xu R, Sciubba DM, et al. Long-term clinical outcomes following en bloc resections for sacral chordomas and chondrosarcomas: a series of twenty consecutive patients. Spine. 2009;34:2233–39.

    Article  PubMed  Google Scholar 

  24. Kayani B, Hanna SA, Sewell MD, Saifuddin A, Molloy S, Briggs TW. A review of the surgical management of sacral chordoma. Eur J Oncol. 2014;40:1412–20.

    Article  CAS  Google Scholar 

  25. Ozaki T, Hillmann A, Winkelmann W. Surgical treatment of sacrococcygeal chordoma. J Surg Oncol. 1997;64:274–79.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge Ms. Keiko Hishiki for administrative support for data collection.

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There are no conflicts of interest.

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Correspondence to Toru Akiyama MD.

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Akiyama, T., Ogura, K., Gokita, T. et al. Analysis of the Infiltrative Features of Chordoma: The Relationship Between Micro-Skip Metastasis and Postoperative Outcomes. Ann Surg Oncol 25, 912–919 (2018). https://doi.org/10.1245/s10434-017-6268-6

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  • DOI: https://doi.org/10.1245/s10434-017-6268-6

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