Prognostic Factors in the Operative Management of Sacral Chordomas

Objective Surgical resection of sacral chordomas offers the best long-term prognosis but has high rates of local recurrence, metastases, and mortality. Most prognostic studies are limited by low patient numbers, variation in treatment, follow-up, and prognostic variables studied. The objective of this study was to identify factors associated with recurrence, metastasis, and survival. Methods Retrospective review of 58 patients undergoing sacrectomy for chordoma with a mean age of 63 years (range: 41–80 years) and a mean follow-up of 45.3 months (range: 2–144 months). Data on prognostic variables and outcomes were collected. Forty-two patients underwent a combined anterior and posterior approach and 16 underwent a posterior-only approach. Results Twenty-six patients (44.8%) died during follow-up. Kaplan-Meier estimates for 5- and 10-year survival were 62% and 26%, respectively. Local recurrence occurred in 32 patients (51.7%) and metastases in 19 (32.7%). Adequacy of resection margins was the most important predictor of disease recurrence, metastases, and survival. Tumors >8 cm were associated with significantly increased risk of metastases and reduced survival ( P Conclusions Patients with inadequate resection margins, tumors >8 cm, sacroiliac joint and/or musculature infiltration, and dedifferentiated disease have significantly worse oncologic outcomes. Involvement of gluteus maximus alone confers a higher risk of metastases and local recurrence than involvement of piriformis and gluteus maximus, or piriformis alone.