Tumor Growth Rate as a New Predictor of Progression-Free Survival After Chordoma Surgery

Neurosurgery 89:291–299, 2021

Currently, different postoperative predictors of chordoma recurrence have been identified. Tumor growth rate (TGR) is an image-based calculation that provides quantitative information of tumor’s volume changing over time and has been shown to predict progression-free survival (PFS) in other tumor types.

OBJECTIVE: To explore the usefulness of TGR as a new preoperative radiological marker for chordoma recurrence.

METHODS: A retrospective single-institution study was carried out including patients reflecting these criteria: confirmed diagnosis of chordoma on pathological analysis, no history of previous radiation, and at least 2 preoperative thin-slice magnetic resonance images available to measure TGR. TGR was calculated for all patients, showing the percentage change in tumor size over 1 mo.

RESULTS: A total of 32 patients were retained for analysis. Patients with a TGR ≥ 10.12%/m had a statistically significantly lower mean PFS (P<.0001). TGR≥10.12%/m (odds ratio=26, P=.001) was observed more frequently in recurrent chordoma. In a subgroup analysis, we found that the association of Ki-67 labeling index≥6% and TGR≥10.12%/m was correlated with recurrence (P = .0008).

CONCLUSION: TGR may be considered as a preoperative radiological indicator of tumor proliferation and seems to preoperatively identify more aggressive tumors with a higher tendency to recur. Our findings suggest that the therapeutic strategy and clinical radiological follow-up of patients with chordoma can be adapted also according to this new parameter.