Analysis of risk factors for recurrence after the resection of sacral chordoma combined with embolization

Yang, Huilin; Zhu, Lifan; Ebraheim, Nabil A.; Liu, Xiaochen; Castillo, Sharmaine; Tang, Tiansi; Liu, Jiayong; Cui, Hongjuan

doi:10.1016/j.spinee.2009.08.447

« Previous Next »The Spine Journal
Volume 9, Issue 12 , Pages 972-980, December 2009

Analysis of risk factors for recurrence after the resection of sacral chordoma combined with embolization

Huilin Yang, MD, PhD
- Department of Orthopaedic Surgery, First Hospital Affiliated to Suzhou University, 188 Shizi Street, Suzhou 215006, China
Lifan Zhu, MD
- Department of Orthopaedic Surgery, First Hospital Affiliated to Suzhou University, 188 Shizi Street, Suzhou 215006, China
Nabil A. Ebraheim, MD
- Department of Orthopaedic Surgery, University of Toledo, 3065 Arlington Avenue, Toledo, OH 43614, USA
Xiaochen Liu, BS
- Department of Orthopaedic Surgery, University of Toledo, 3065 Arlington Avenue, Toledo, OH 43614, USA
Sharmaine Castillo, BS
- Department of Orthopaedic Surgery, University of Toledo, 3065 Arlington Avenue, Toledo, OH 43614, USA
Tiansi Tang, MD
- Department of Orthopaedic Surgery, First Hospital Affiliated to Suzhou University, 188 Shizi Street, Suzhou 215006, China
Jiayong Liu, MD
- Department of Orthopaedic Surgery, University of Toledo, 3065 Arlington Avenue, Toledo, OH 43614, USA
- Corresponding author. Department of Orthopaedic Surgery, University of Toledo, 3065 Arlington Ave., Toledo, OH 43614, USA. Tel.: (419) 383-6558; fax: (419) 383-3526.
Hongjuan Cui, PhD
- Department of Stem Cell Biology and Regenerative Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA

Received 27 May 2009; received in revised form 28 July 2009; accepted 21 August 2009. published online 05 October 2009.

Abstract

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.

Keywords: Sacrum, Chordoma, Recurrence, Embolization, PCNA, bFGF, Continuous disease-free survival time