Risk Factors for Developing Metastasis in Chordomas: A Retrospective Analysis of 194 Patients

Objectives Skull base chordomas (SBC) are rare and locally aggressive tumors with the potential for metastasis. This study aimed to identify clinical, histopathological, and molecular risk factors for the development of metastasis in patients with chordomas across the axial skeleton. Design Retrospective, single-center cohort study with multivariable logistic regression to identify independent risk factors for metastasis. Setting Single tertiary care center; patients treated between January 2001 and June 2020. Participants A total of 194 patients with chordomas treated during the study period. Main Outcome Measures Development of metastasis during follow-up; time to metastasis and frequency of distant spread. Candidate predictors included age, gender, tumor location, Ki67 proliferation index, and chromosomal aberrations. Results Among 194 patients, 20 (10.3%) developed metastasis during a mean overall follow-up of 65.4 months; mean follow-up among the metastatic subgroup was 93.9 months. On multivariate analysis, higher Ki67 index (OR, 1.07; 95% CI, 1.01–1.14; P = 0.02) and tumor location at the craniocervical junction (OR, 4.91; 95% CI, 1.44–15.77; P = 0.01) were associated with increased odds of metastasis. Male gender was associated with lower odds of metastasis (OR, 0.31; 95% CI, 0.10–0.84; P = 0.03), indicating female gender as the higher-risk category. Conclusions Higher Ki67 index, craniocervical junction location, and female gender are key risk factors for metastasis in chordoma patients. Early identification of high-risk patients may support more aggressive surveillance and tailored therapeutic strategies across chordoma types.