Prognostic Factors in Clival Chordomas: An Integrated Analysis of 347 Patients

Objective: To investigate prognostic factors of clival chordoma using the largest patient set to date. Methods: Appropriate studies were identified per search criteria, data satisfying criteria were extracted, and survival analysis was performed to investigate prognostic factors of clival chordoma. Results: A total of 347 patients from the literature cohort met our inclusion criteria. Of 346 cases in which extent of resection was reported, gross total resection (GTR), subtotal resection, and biopsy were achieved in 118 (34.1%), 205 (59.2%), and 21 (6.1%) cases, respectively. Two (0.6%) subjects did not undergo surgery. Of 185 cases in which surgical approach was reported, 56 (30.3%) underwent an endoscopic transoral approach, 17 (9.2%) microscopic transsphenoidal, 45 (24.3%) endoscopic or microscopic, 45 (24.3%) craniotomy, and 22 (11.9%) other approaches. There was no significant difference in GTR rates of different surgical approaches (P = 0.101). Median follow-up was 46.6 months. The 5- and 10-year rates for progression-free survival (PFS) were 59.2% and 47.9%, respectively. The 5- and 10-year rates for overall survival (OS) were 77.3% and 63.9%, respectively. On multivariate analysis for both PFS and OS, GTR demonstrated significantly improved outcomes when compared with subtotal resection (hazard ratio 0.45, 95% confidence interval 0.22–0.90, P = 0.025 for PFS; hazard ratio 0.20, confidence interval 0.06–0.65, P = 0.008 for OS). Conclusions: GTR rates were comparable in different surgical approaches. GTR was a significant predictor of longer PFS and OS in clival chordoma.