An institutional review of clinical outcomes for skull base chordoma: an analysis of 269 cases over 19 years.

Abstract

The aim of the present study was to review the surgical outcomes of endoscopic skull base surgery (ESBS) for the treatment of skull base chordoma (SBC) at the authors' institution over the past 2 decades. The electronic medical records of patients who underwent resection of primary SBC at the University of Pittsburgh Medical Center from 2001 to 2020 were retrospectively reviewed. Patients were split into two groups: primary or recurrent tumor. The primary outcome in this analysis was extent of resection. Secondary outcomes included progression-free survival (PFS) and complications. This analysis included 194 individual patients on whom 269 total resections were performed. Within the authors' sample, 95 resections were for primary tumors and 174 resections were for recurrent tumors. The mean PFS among tumor patients who received gross-total resection (GTR) was 103.5 months, near-total resection (NTR) was 27.1 months, and subtotal resection (STR) was 12.2 months. Not accounting for adjuvant radiation, GTR allowed for significantly longer PFS than NTR (p < 0.001) or STR (p < 0.001). For tumors that did not receive adjuvant radiation, GTR allowed for significantly longer PFS than non-GTR (p = 0.013). The factors that were associated with GTR were prior radiation (OR 0.302) and institutional experience (OR 1.225). The percentage of GTRs among all tumors in our sample increased significantly and incrementally from 2001 to 2020 (7.7% to 78%, p < 0.001). GTR is an important factor influencing PFS in patients with SBC. Experience with ESBS has a significant effect on outcomes. GTR rates (especially for recurrent tumors) and incidence of complications have improved at the authors' institution, which may be correlated to institutional experience.