• S H Bakker, Jacobs W C H WCH Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands., W Pondaag, H Gelderblom, R A Nout, Dijkstra P D S PDS Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands., W C Peul, and Vleggeert-Lankamp C L A CLA Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands..
• Department of Neurosurgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. s.h.bakker@lumc.nl.
• Eur Spine J. 2018 Dec 1; 27 (12): 3043-3058.

Background And AimsThe aim of this systematic review is to describe the epidemiology of chordoma and to provide a clear overview of clinical prognostic factors predicting progression-free and overall survival.MethodsFour databases of medical literature were searched. Separate searches were performed for each of the two objectives. Reference and citation tracking was performed. Papers were processed by two independent reviewers according to a protocol that included risk of bias analysis. Disagreement was resolved by discussion. Pooled analyses were planned if homogeneity of data would allow.ResultsIncidence-incidence rates ranged between 0.18 and 0.84 per million persons per year and varied between countries and presumably between races. On average patients were diagnosed in their late fifties and gender data indicate clear male predominance. Two of the largest studies (n = 400 and n = 544) reported different anatomical distributions: one reporting the skull base and sacrococcygeal area affected in 32% and 29% of cases, whereas the other reporting that they were affected in 26% and 45% of cases, respectively.Prognostic FactorsStatistically significant adverse prognostic factors predicting progression-free and overall survival include female sex, older age, bigger tumour size, increasing extent of tumour invasion, non-total resection, presence of metastasis, local recurrence, and dedifferentiated histological subtype.ConclusionsIncidence rate and anatomical distribution vary between countries and presumably between races. Most chordomas arise in the skull base and sacrococcygeal spine, and the tumour shows clear male predominance. Multiple adverse prognostic factors predicting progression-free and overall survival were identified in subgroups of patients. These slides can be retrieved under Electronic Supplementary Material.

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