Male sex as a risk factor for the clinical course of skull base chordomas: Clinical article

Walter Rachinger, Sabina Eigenbrod, Stephan Dützmann, Matthias Simon, Guenther C. Feigl, Natalia Kremenevskaja, Hans Kretzschmar, Stefan Zausinger, Friedrich Wilhelm Kreth, Niklas Thon, Jörg Christian Tonn

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

Object. Chordomas of the skull base are rare and locally invasive and have a poor prognosis. The aim of this retrospective multicenter study was to evaluate the current pattern of care and clinical course and to identify prognostic factors. Methods. A total of 47 patients (26 men; mean age 48.5 years) treated in 5 centers were included. Histology was centrally reviewed; additionally, semiquantitative N- and E-cadherin expression analysis was performed. Prognostic factors were obtained from multivariate regression models. For survival analysis the Kaplan-Meier method was used. Results. The median follow-up period was 5.2 years. Complete resection, incomplete resection, and extended biopsy were performed in 14.9%, 80.9%, and 4.3% of patients, respectively. Surgical morbidity was not associated with extent of resection. Adjuvant radiation therapy was performed in 30 (63.8%) of 47 patients. The median progression-free survival (PFS) was 7.3 years. Complete resection prolonged median overall survival (OS) (p = 0.04). Male patients presented with worse PFS (4.8 years vs 9.8 years; p = 0.04) and OS (8.3 years vs not reached; p = 0.03) even though complete resection was exclusively achieved in the male subpopulation. Multivariate analysis confirmed male sex as the most important risk factor for tumor progression (p = 0.04) and death (p = 0.02). Age, duration of symptoms, initial Karnofsky Performance Scale score, brainstem compression, involvement of the petrous bone, infiltration of the dura mater, modality and dose of radiation therapy, and the E- and N-cadherin expression patterns did not gain prognostic relevance. Conclusions. In skull base chordomas, male patients bear a higher risk of progressive disease and death. Male patients might benefit from more aggressive adjuvant therapy and/or from a closer follow-up schedule.

Original languageEnglish (US)
Pages (from-to)1313-1320
Number of pages8
JournalJournal of Neurosurgery
Volume120
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • Cadherin
  • Chordoma
  • Prognostic factors
  • Sex
  • Skull base

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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