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Analysis of the Infiltrative Features of Chordoma: The Relationship Between Micro-Skip Metastasis and Postoperative Outcomes

Toru Akiyama MD, Koichi Ogura MD, Tabu Gokita MD, PhD, Satoshi Tsukushi MD, PhD, Shintaro Iwata MD, PhD, Tomoki Nakamura MD, PhD, Akihiko Matsumine MD, PhD, Tsukasa Yonemoto MD, PhD, Yoshihiro Nishida MD, PhD, Kazuo Saita MD, PhD, Akira Kawai MD, PhD, Seiichi Matsumoto MD, PhD, Takehiko Yamaguchi MD, PhD
Bone and Soft Tissue Sarcomas
Volume 25, Issue 4 / April , 2018



Chordomas are very rare primary malignant bone tumors that arise commonly from the sacrum (50–60%) and clivus (25–35%). Chordomas have a high rate of recurrence. The authors confirmed a unique histologic infiltration pattern of chordomas that resembles a skip-metastatic lesion in normal tissue around tumor, which they named “micro-skip metastasis.” This study aimed to examine the correlations between the clinicopathologic features of chordomas, including micro-skip metastasis, and the clinical outcomes, including overall survival, local recurrence-free survival, and distant metastasis-free survival.


The study analyzed histopathologic and clinical data from patients with sacral chordomas who underwent en bloc resection from July 1991 through July 2014. Cases with a minimum follow-up period shorter than 20 months after resection were excluded. Kaplan–Meier survival analyses with log-rank tests were performed for overall survival, metastasis-free survival, and recurrence-free survival.


The study retrospectively reviewed 40 patients. The mean follow-up period was 98.2 months (range 22–297 months). The local recurrence rate was 41.3%. Micro-skip metastases, observed in 17 patients (42.5%), were associated with a significantly increased risk of local recurrence (p = 0.023) but not with overall survival or distant metastasis-free survival. Poorer overall survival was associated with histologic vascular invasion (p = 0.030) and a greater maximum tumor diameter (p = 0.050).


The presence of micro-skip metastasis was associated with a higher rate of local recurrence. The maximum tumor diameter and the presence of histologic vascular invasion were associated with poorer overall survival.

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