Original ArticleDifferences in Dural Penetration of Clival Chordomas Are Associated with Different Prognosis and Expression of Platelet-Derived Growth Factor Receptor-β
Introduction
Chordomas are rare, locally invasive bone tumors, originating from notochordal remnants.1 They are often located in the axial skeleton: 50% in the sacrococcygeal region, 35% in the clivus region, and 15% in the vertebrae.2 Chordomas often adhere to and infiltrate some important structures, so it is difficult to achieve total resection, resulting in high recurrence rates. With a high recurrence rate and resistance to radiotherapy and chemotherapy, clival chordomas are still a challenge in neurosurgery. With the administration of proton radiation therapy3 and targeted drugs such as imatinib4 and rapamycin,5 prognosis has been improved but it is still far from satisfactory.
According to our clinical experience, clivus chordomas show different degrees of dural penetration: Some show little or no dura mater invasion, with extensive skull base bone invasion, and some mainly invade the dura matter, with little bone invasion. In this study, we investigated whether degree of dural penetration was related to prognosis.
The platelet-derived growth factor receptor (PDGFR)-β signaling pathway is activated in many tumors and implicated in numerous cellular processes such as growth and survival, promotion of angiogenesis, and epithelial-mesenchymal transition.6 It has been reported that PDGFR-β expression was elevated in meningiomas than dura mater and was related to migration ability of meningioma cells.7 We consider that dural penetration of clival chordomas may be related to the PDGFR-β signaling pathway. To explore the mechanisms involved in the different degrees of dural penetration, we used tissue microarray technology and immunohistochemistry to compare expression levels of protein in the PDGFR-β signaling pathway. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and Western blotting were performed to validate the results of immunohistochemistry.
Section snippets
Case Selection Criteria
We reviewed patients who underwent surgery between January 2008 and September 2014 in Beijing Tiantan Hospital, Capital Medical University. We found that the chordomas presented very different growth patterns: Some presented dural invasion dominated, some presented bone invasion dominated, and others presented extensive invasion. At the median level of T1-contrast sagittal magnetic resonance imaging (MRI), the line of the dorsum sellae connected to the anterior margin of the foramen magnum was
Patient Summary
There were 67 patients included in the study: 33 in Type I and 34 in Type II (Table 1). In Type I, there were 22 men and 11 women with a mean age (±SD) of 49.79 (±11.28) years. In Type II, there were 24 men and 10 women with a mean age (±SD) of 37.32 (±14.21) years. The median volume (interquartile range) of tumor was 14,000 (18,811) mm3 in Type I and 14,250.0 (16,788.42) mm3 in Type II. The most frequent complaints included diplopia (18 in Type I and 17 in Type II), headache (7 in Type I and
Discussion
OS was significantly correlated with degree of dural penetration and age. OS of Type I was significantly longer than that of Type II. We considered that it was related to the higher rate of complications in Type II. In Type I, chordomas showed little or no dural invasion. For this type of tumor, the endoscopic trans-sphenoidal approach had the advantages of easier exposure and clearer vision compared with craniotomy. Thus the endoscopic trans-sphenoidal approach was used in most cases (90.9%)
Conclusions
Clival chordomas have different degrees of dural penetration. Patients with chordomas with serious dural penetration have poorer prognosis. Higher expression of PDGFR-β is related to more serious dural penetration of clival chordomas.
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Natural Growth Dynamics of Untreated Skull Base Chordomas In Vivo
2020, World NeurosurgeryCitation Excerpt :The present data showed that tumors of endophytic growth showed higher growth rates, which needed further investigation, such as matrix metallopeptidase expression.27,28 On the other hand, breaking through the dura mater and forming a subdural area of the tumor, which leads to deteriorated symptoms or brainstem depression symptoms, results in poor postoperative quality of life and likelihood of recurrence.29,30 However, the present data were questioned because dura mater breakthrough was determined via the review of surgical documents.
Prognostic Factors in Skull Base Chordoma: A Systematic Literature Review and Meta-Analysis
2018, World NeurosurgeryCitation Excerpt :For the sake of valid comparison, we classified tumor excision as marginal resection (MR) (defined as resection of >90% of the tumor) or intralesional resection (IR) (defined as resection of <90% of the tumor), referring to a previous report.41 We also recorded extent of resection as total resection (TR) when no residual tumor was detected in postoperative imaging and intraoperative inspection; otherwise, nontotal resection (NTR) was determined.21,37 In results pooling, we found that 7 studies evaluated extent of tumor resection as a predictive factor of progression-free survival (PFS), but 5 studies provided data comparing IR with MR and 2 studies provided data comparing NTR with TR.
Drs Zhai and Bai authors contributed equally to this work.
Conflict of interest statement: The authors declare that they have no conflicts of interest. This work was supported by the Research Special Fund For Public Welfare Industry of Health (201402008), National High Technology Research and Development Program of China (863 Program, 2014AA020610), National Natural Science Foundation of China (30971005), and Innovation Foundation of Beijing Neurosurgical Institute (Youth-2014008).