The Study Of Chordomas Recurrence With Clinicopathology And Immunohistochemical Methods

Objective: Chordoma , a rare tumor , which presentes at human axial skeleton, can impair the central neverous system. It has a high recurrence rate and the poor prognosis is bad. The most study of chordomas focuses on it's tissue origin via immunohistochemical methods. There was still no potential indicator to evaluate the recurrence and prognosis, which makes the diagnosis and therapy dubious. The patients usually died from the tumor invasion and metastasis. Tumor cell invasion and metastasis require destruction of the extracelluar matrix(ECM) in local invasion. Protease plays an important role in the degradation of ECM. In the present study, the expression of Cath-D, MMP-13, PCNA and P⁵³ were detected in 45 cases of chordoma to investigate the pathology feature of chordoma, and try to illuminate the possible mechanism of the invasion and recurrence of tumor.Methods: 45 chordoma cases were available from Qilu Hospital, Shandong Provincial Hospital, General Hospital of Jinan Military District and Number 4 Hospital of Jinan. The history, following up investigate and the paraffin specimens were got. Paraffin slides of the same sample were stained with H-E for histology study, and treated with P⁵³ , PCNA, Cat-D, MMP-13 antibody by SP immunohistochemistry method. The data were analyzed with SPSS for windows 10.0.Results: In our 45 cases chordoma study, 22 cases were mainly composed of physaliferouslike cells, 23 cases astral cells. There were 19 cases with osseous metaplasia, of which 18 cases accompanied with invasion. 25 cases recurred, which occupied 55.56%, 2 cases recurred twice and 2 cases died . 29 cases expressed P53, in which 9 is positive in the recurrence group, 7 positive in non-recurrence. P53 was positive in 42.22% cases. The expression of the recurrence group(56 %) was significantly higher than that of the non-recurrence group. PCNA was positive in 65.33% chordmoas, and positive in 96% recurrence group. Positive rate of Cath-D was 88.88%, and higher in the recurrence group than that in the non-recurrence group significantly. MMP-13 expressed in 84.44% chordomas and the positive rate was 88% in recurrence group. In the cases with invasion, p53, PCNA, Cath-D and MMP-13 over-expressed significantly.Conclusion:1. Although chordoma behaviors low malignant histology character, and yet it assumes high malignant feature for its high recurrence rate, thus there is heterogeneity between histopathology and biology idiosyncrasy of chordoma.In the present study, sex, age, the site, the tumor size and heterotye were not associated with the recurrence of chordoma. The following histological signs: physaliferouslike cell type, invasion and non-ossification were found to be adverse prognosis, so clinicopathology may be assistant indicator to evaluate the prognosis.2. P53 and PCNA were correlated with recurrence of chordoma. Cath-D and MMP-13 was associated with the invasive ability and recurrence closely. Over-expression of Cath-D and MMP-13 was an indicator of an unfavorable clinical outcome in chordoma. Whether they can be defined as indicators depends on further study.3. Cath-D was associated with MMP-13, which hints the two protease cooperate in the ECM degradation, and promote the invasion and recurrence of tumor.4. The present study provides some immunohistochemical marks to help to diagnose chordoma. In some sense, the possible mechanism of invasion and recurrence of chordomas, chordomas synthesize and excrete proteases to degrade theECM and then enhance the invasion of tumor cell, and thus result in the recurrence.