scholarly journals Multivariate Analysis and Validation of the Prognostic Factors for Skull Base Chordoma

2021 ◽  
Vol 8 ◽  
Author(s):  
Chubei Teng ◽  
Qi Yang ◽  
Zujian Xiong ◽  
Ningrong Ye ◽  
Xuejun Li
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Tumor Size ◽  
Postoperative Radiotherapy ◽  
Primary Site ◽  
Disease Stage ◽  
Independent Data ◽  
Data Set ◽  
Factors Affecting ◽  
Skull Base Chordoma

Background: Skull base chordoma is a rare tumor with low-grade malignancy and a high recurrence rate, the factors affecting the prognosis of patients need to be further studied. For that, we investigated prognostic factors of skull base chordoma through the database of the Surveillance, Epidemiology, and End Results (SEER) program, and validated in an independent data set from the Xiangya Hospital.Methods: Six hundred and forty-three patients diagnosed with skull base chordoma were obtained from the SEER database (606 patients) and the Xiangya Hospital (37 patients). Categorical variables were selected by Chi-square test with a statistical difference. Survival curves were constructed by Kaplan–Meier analysis and compared by log-rank test. Univariate and multivariate Cox regression analyses were used to explore the prognostic factors. Propensity score matching (PSM) analysis was undertaken to reduce the substantial bias between gross total resection (GTR) and subtotal resection (STR) groups. Furthermore, clinical data of 37 patients from the Xiangya Hospital were used as validation cohorts to check the survival impacts of the extent of resection and adjuvant radiotherapy on prognosis.Results: We found that age at diagnosis, primary site, disease stage, surgical treatment, and tumor size was significantly associated with the prognosis of skull base chordoma. PSM analysis revealed that there was no significant difference in the OS between GTR and STR (p = 0.157). Independent data set from the Xiangya Hospital proved no statistical difference in OS between GTR and STR groups (p = 0.16), but the GTR group was superior to the STR group for progression-free survival (PFS) (p = 0.048). Postoperative radiotherapy does not improve OS (p = 0.28), but it can prolong PFS (p = 0.0037). Nomograms predicting 5- and 10-year OS and DSS were constructed based on statistically significant factors identified by multivariate Cox analysis. Age, primary site, tumor size, surgical treatment, and disease stage were included as prognostic predictors in the nomograms with good performance.Conclusions: We identified age, tumor size, surgery, primary site, and tumor stage as main factors affecting the prognosis of the skull base chordoma. Resection of the tumor as much as possible while ensuring safety, combined with postoperative radiotherapy may be the optimum treatment for skull base chordoma.

scholarly journals Radiomics and Dosiomics for Predicting Local Control after Carbon-Ion Radiotherapy in Skull-Base Chordoma

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 339
Author(s):  
Giulia Buizza ◽  
Chiara Paganelli ◽  
Emma D’Ippolito ◽  
Giulia Fontana ◽  
Silvia Molinelli ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Local Control ◽  
Tumour Progression ◽  
Risk Groups ◽  
Carbon Ion Radiotherapy ◽  
Survival Models ◽  
Carbon Ion ◽  
Combined Models ◽  
Skull Base Chordoma

Skull-base chordoma (SBC) can be treated with carbon ion radiotherapy (CIRT) to improve local control (LC). The study aimed to explore the role of multi-parametric radiomic, dosiomic and clinical features as prognostic factors for LC in SBC patients undergoing CIRT. Before CIRT, 57 patients underwent MR and CT imaging, from which tumour contours and dose maps were obtained. MRI and CT-based radiomic, and dosiomic features were selected and fed to two survival models, singularly or by combining them with clinical factors. Adverse LC was given by in-field recurrence or tumour progression. The dataset was split in development and test sets and the models’ performance evaluated using the concordance index (C-index). Patients were then assigned a low- or high-risk score. Survival curves were estimated, and risk groups compared through log-rank tests (after Bonferroni correction α = 0.0083). The best performing models were built on features describing tumour shape and dosiomic heterogeneity (median/interquartile range validation C-index: 0.80/024 and 0.79/0.26), followed by combined (0.73/0.30 and 0.75/0.27) and CT-based models (0.77/0.24 and 0.64/0.28). Dosiomic and combined models could consistently stratify patients in two significantly different groups. Dosiomic and multi-parametric radiomic features showed to be promising prognostic factors for LC in SBC treated with CIRT.

scholarly journals Predictors of outcome in pleomorphic xanthoastrocytoma

2020 ◽  
Author(s):  
Antonio Dono ◽  
Victor Lopez-Rivera ◽  
Ankush Chandra ◽  
Cole T Lewis ◽  
Rania Abdelkhaleq ◽  
...  
Keyword(s):  
Tumor Size ◽  
Postoperative Radiotherapy ◽  
Treatment Strategies ◽  
Pleomorphic Xanthoastrocytoma ◽  
Survival Outcomes ◽  
Factors Affecting ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Male Patients

Abstract Background Pleomorphic xanthoastrocytomas (PXA) are circumscribed gliomas that typically have a favorable prognosis. Limited studies have revealed factors affecting survival outcomes in PXA. Here, we analyzed the largest PXA dataset in the literature and identify factors associated with outcomes. Methods Using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries database, we identified histologically confirmed PXA patients between 1994 and 2016. Overall survival (OS) was analyzed using Kaplan-Meier survival and multivariable Cox proportional hazard models. Results In total, 470 patients were diagnosed with PXA (males = 53%; median age = 23 years [14-39 years]), the majority were Caucasian (n = 367; 78%). The estimated mean OS was 193 months [95% CI: 179-206]. Multivariate analysis revealed that greater age at diagnosis (≥39 years) (3.78 [2.16-6.59], P < .0001), larger tumor size (≥30 mm) (1.97 [1.05-3.71], P = .034), and postoperative radiotherapy (RT) (2.20 [1.31-3.69], P = .003) were independent predictors of poor OS. Pediatric PXA patients had improved survival outcomes compared to their adult counterparts, in which chemotherapy (CT) was associated with worse OS. Meanwhile, in adults, females and patients with temporal lobe tumors had an improved survival; conversely, tumor size ≥30 mm and postoperative RT were associated with poor OS. Conclusions In PXA, older age and larger tumor size at diagnosis are risk factors for poor OS, while pediatric patients have remarkably improved survival. Postoperative RT and CT appear to be ineffective treatment strategies while achieving GTR confer an improved survival in male patients and remains the cornerstone of treatment. These findings can help optimize PXA treatment while minimizing side effects. However, further studies of PXAs with molecular characterization are needed.

Prognostic Factors in Skull Base Chordoma: A Systematic Literature Review and Meta-Analysis

2018 ◽  
Vol 109 ◽  
pp. 307-327 ◽  
Author(s):  
Ming-Xiang Zou ◽  
Guo-Hua Lv ◽  
Qian-Shi Zhang ◽  
Shao-Fu Wang ◽  
Jing Li ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Literature Review ◽  
Skull Base ◽  
Systematic Literature Review ◽  
Meta Analysis ◽  
Skull Base Chordoma

scholarly journals Proteomics Analysis Identified ASNS as a Novel Biomarker for Predicting Recurrence of Skull Base Chordoma

2021 ◽  
Vol 11 ◽  
Author(s):  
Yutao Shen ◽  
Mingxuan Li ◽  
Yujia Xiong ◽  
Songbai Gui ◽  
Jiwei Bai ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Skull Base ◽  
Validation Cohort ◽  
High Expression ◽  
Migration And Invasion ◽  
Training Cohort ◽  
Cox Regression Analysis ◽  
Potential Biomarker ◽  
Skull Base Chordoma

BackgroundThe prognostic factors of skull base chordoma associated with outcomes of patients after surgery remain inadequately identified. This study was designed to identify a novel prognostic factor for patients with skull base chordoma.MethodUsing a proteomic technique, the tumor biomarkers that were upregulated in the rapid-recurrence group of chordoma were screened and then narrowed down by bioinformatic analysis. Finally one potential biomarker was chosen for validation by immunohistochemistry using tissue microarray (TMA). A total of 187 patients included in TMA were randomly divided into two cohorts, the training cohort included 93 patients and the validation cohort included 94 patients. Kaplan-Meier survival analysis was used to assess the patients’ survival. Univariable and multivariable Cox regression analysis were used to identify prognostic factors predicting recurrence-free survival (RFS). CCK-8 assay, clonal formation assay and transwell assay were used to test the effect of asparagine synthetase (ASNS) on the proliferation, migration and invasion in chordoma cell lines.ResultsAmong 146 upregulated proteins, ASNS was chosen as a potential prognostic biomarker after bioinformatics analysis. The H-scores of ASNS ranged from 106.27 to 239.58 in TMA. High expression of ASNS was correlated with shorter RFS in both the training cohort (p = 0.0093) and validation cohort (p < 0.001). Knockdown of ASNS by small interfering RNA (siRNA) inhibited the growth, colony formation, migration and invasion of chordoma cells in vitro.ConclusionThis study indicates that high expression of ASNS is correlated with poor prognosis of patients with skull base chordoma. ASNS may be a useful prognostic factor for patients with skull base chordoma.

scholarly journals Characteristics and Prognostic Factors of Patients With Osteosarcoma Older Than 60 Years From the SEER Database

2019 ◽  
Vol 26 (1) ◽  
pp. 107327481988889 ◽  
Author(s):  
Yue Pan ◽  
Daqi Chen ◽  
Taobo Hu ◽  
Guohua Lv ◽  
Zhehao Dai
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Distant Metastasis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Disease Stage ◽  
Data Set ◽  
Primary Tumor Site ◽  
Histologic Subtype ◽  
Axial Location

Osteosarcoma is predominant in the adolescent and the elderly population, but few studies have described the characteristics and prognostic factors of patients older than 60 years. In this study, the Surveillance, Epidemiology, and End Results registry database was used to identify all patients diagnosed with primary osteosarcoma from 1973 to 2014. We utilized Cox proportional hazards regression analysis to evaluate the association between patient overall survival and relevant characteristics, including gender, race, disease stage, treatment methods, primary tumor site, differentiation grade, and histologic subtype. In the data set, a total of 1139 patients with osteosarcoma older than 60 years old were identified. The overall rate of distant metastatic cases was 28.6%. Osteosarcoma occurred equally in men and women (49.5% vs 50.5%). Of all, 41.3% of tumors were located in axial location (pelvis, spine, and ribs), 34.1% of tumors were located in extremity (long or short bones of the upper or lower extremity), and 24.6% in other location (mandible, skull, and other atypical locations). Male (hazard ratio [HR] = 1.201; 95% confidence interval [CI]: 1.056-1.366), axial location (HR = 1.342; 95% CI: 1.157-1.556), distant metastasis (HR = 2.369; 95% CI: 2.015-2.785), non-surgery perform (HR = 2.108; 95% CI: 1.814-2.451) were independent risk factors for 5-year overall survival. This study revealed distinct clinicopathological features of patients with osteosarcoma older than 60 years. Male gender, tumor in axial site, nonsurgery perform, and distant metastasis indicated worse prognosis survival. Performing surgery is still an effective and reliable treatment method for patients older than 60 years.

Letter to the Editor. Prognostic factors in skull base chordoma

2018 ◽  
Vol 128 (5) ◽  
pp. 1598-1599
Author(s):  
Ming-Xiang Zou ◽  
Guo-Hua Lv ◽  
Xiao-Bin Wang ◽  
Jing Li
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Letter To The Editor ◽  
Skull Base Chordoma

scholarly journals RTHP-29. HYPOFRACTIONNATED RADIOTHERAPY FOR REFRACTORY SKULL BASE CHORDOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi215-vi216
Author(s):  
Linbo Cai ◽  
Shaoqun Li ◽  
Mingyao Lai ◽  
Changguo Shan ◽  
Juan Li ◽  
...  
Keyword(s):  
Overall Survival ◽  
Skull Base ◽  
Tumor Recurrence ◽  
Postoperative Radiotherapy ◽  
Subtotal Resection ◽  
Therapeutic Effects ◽  
Conventional Fractionation ◽  
Kaplan Meier ◽  
Radiation Induced ◽  
Skull Base Chordoma

Abstract OBJECTIVE Skull base chordoma is difficult to be totally excised by surgery because of the complex anatomical structures of skull base. Postoperative radiotherapy is one of the most important treatment options for skull base chordoma. However, the response of chordoma to conventional fractionation radiotherapy is poor. Therefore, it is of great value to explore the therapeutic effects of hypofractionnated radiotherapy for refractory skull base chordoma. METHODS A retrospective analysis was performed on the clinical data of patients with refractory skull base chordomas who were admitted to Guangdong Sanjiu Brain Hospital from 2007 to April 2019. The characteristics of the selected cases and prognosis-related factors were analyzed with Kaplan-Meier method. RESULTS A total of 21 patients were enrolled in this study, including 11 male (52.4%) and 10 female (47.6%). Twenty patients received surgery, including gross total resection in 5 cases (25%), subtotal resection in 14 cases (70%) and biopsy in 1 case (5%). Among 18 patients who received radiotherapy, 17 (94.4%) received radiotherapy after the first diagnosis; 1 (5.6%) were treated with radiotherapy after tumor recurrence; and 3 (16.7%) received the secondary radiotherapy after tumor recurrence. The median overall survival of 11 patients receiving hypofractionnated radiotherapy (45-60Gy/8-20F) and 7 patients receiving conventional fractionation radiotherapy (40-60Gy/20-30F) reached 33 months (7–130) and 68 months (27–105), respectively. The results of Kaplan-Meier analysis revealed that the overall survival of patients who were treated with hypofractionnated radiotherapy was significantly longer than that of those receiving conventional fractionation radiotherapy. No one suffered from radiation-induced acute brain injury (≥grade 3), and only 1 patient who received hypofractionnated radiotherapy developed radiation-induced brain necrosis at 3 years after hypofractionnated radiotherapy. CONCLUSION Hypofractionnated radiotherapy for refractory skull base chordoma can not only achieve a therapeutic effect, but also reduce the risk of radiation-induced necrosis.

scholarly journals Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review

Pituitary ◽  
2021 ◽  
Author(s):  
Liu-Dong Wei ◽  
Chao Li ◽  
Da Li ◽  
Xing-Ju Liu ◽  
Run-Ting Li ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Cox Regression ◽  
Postoperative Radiotherapy ◽  
Residual Tumor ◽  
Optimal Treatment ◽  
Multivariate Logistic Regression Model ◽  
Tumor Diameter ◽  
Ki 67 ◽  
Factors Affecting ◽  
Cox Regression Analysis

Abstract Purpose Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis. Methods We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression. Results In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008–8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015–12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240–15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335–17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020–9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486–309.595; p = 0.001). Conclusion Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.

scholarly journals Proton and carbon ion radiotherapy in skull base chordomas: a prospective study based on a dual particle and a patient-customized treatment strategy

2020 ◽  
Vol 22 (9) ◽  
pp. 1348-1358 ◽  
Author(s):  
Alberto Iannalfi ◽  
Emma D’Ippolito ◽  
Giulia Riva ◽  
Silvia Molinelli ◽  
Sara Gandini ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Skull Base ◽  
Organs At Risk ◽  
High Rate ◽  
Carbon Ion Radiotherapy ◽  
Particle Therapy ◽  
Carbon Ion ◽  
Brainstem Compression ◽  
Optic Pathways ◽  
Skull Base Chordoma

Abstract Background The aim of this study is to evaluate results in terms of local control (LC), overall survival (OS), and toxicity profile and to better identify factors influencing clinical outcome of skull base chordoma treated with proton therapy (PT) and carbon ion radiotherapy (CIRT). Methods We prospectively collected and analyzed data of 135 patients treated between November 2011 and December 2018. Total prescription dose in the PT group (70 patients) and CIRT group (65 patients) was 74 Gy relative biological effectiveness (RBE) delivered in 37 fractions and 70.4 Gy(RBE) delivered in 16 fractions, respectively (CIRT in unfavorable patients). LC and OS were evaluated using the Kaplan–Meier method. Univariate and multivariate analyses were performed, to identify prognostic factors on clinical outcomes. Results After a median follow-up of 44 (range, 6–87) months, 14 (21%) and 8 (11%) local failures were observed in CIRT and PT group, respectively. Five-year LC rate was 71% in CIRT cohort and 84% in PT cohort. The estimated 5-year OS rate in the CIRT and PT group was 82% and 83%, respectively. On multivariate analysis, gross tumor volume (GTV), optic pathways, and/or brainstem compression and dose coverage are independent prognostic factors of local failure risk. High rate toxicity grade ≥3 was reported in 11% of patients. Conclusions Particle radiotherapy is an effective treatment for skull base chordoma with acceptable late toxicity. GTV, optic pathways, and/or brainstem compression and target coverage were independent prognostic factors for LC. Key Points • Proton and carbon ion therapy are effective and safe in skull base chordoma. • Prognostic factors are GTV, organs at risk compression, and dose coverage. • Dual particle therapy and customized strategy was adopted.

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