脊索瘤是一种罕见的肿瘤，无论是否进行切缘阴性的手术和术后放疗，通常都会复发。广泛使用的免疫组织化学 (IHC) 标记物在解决颅底脊索瘤 (SBC) 复发方面的预测准确性尚未确定。本研究旨在调查 IHC 标志物在预测 SBC 切除辅助放射治疗后复发中的作用。作者回顾了 2017 年 1 月至 2021 年 6 月期间明尼苏达州、佛罗里达州和亚利桑那州 Mayo Clinic 接受 SBC 治疗的患者记录。排除标准包括没有组织病理学或复发结果的患者。组织病理学标记物仅包括细胞角蛋白 A1/A3、上皮膜抗原 (EMA)、S100 蛋白、泛细胞角蛋白、IN1、GATA3、CAM5.2、OSCAR 和软骨样。从患者记录中提取信息，包括治疗、临床和放射学随访持续时间、人口统计学和组织病理学因素。训练和测试决策树和随机森林分类器，以使用 80/20 分割基于未见过的数据来预测复发。共有 38 名诊断为 SBC 的患者接受了切除术（全切除：42.1%；次全切除） ：57.9%）和放射治疗是从病历中提取的。患者平均年龄为 48.2 (SD 19.6) 岁；大多数患者是男性（n = 23；60.5%）和白人（n = 36；94.7%）。全细胞角蛋白与切除和辅助放疗后术后复发风险增加相关（OR 14.67，95% CI 2.44-88.13；p = 0.00517）。决策树分析发现，全细胞角蛋白阳性肿瘤有 78% 的机会被归类为复发，准确度为 75%。预测术后复发的最小深度分布表明，最重要的变量是全细胞角蛋白，其次是细胞角蛋白 A1/A3 和 EMA。作者的机器学习算法将全细胞角蛋白确定为其他 IHC 中复发的最大贡献者SBC 切除后的标记。机器学习可能有助于预测罕见肿瘤（例如脊索瘤）的结果。

Chordomas are rare tumors that often recur regardless of surgery with negative margins and postoperative radiotherapy. The predictive accuracy of widely used immunohistochemical (IHC) markers in addressing the recurrence of skull base chordomas (SBCs) is yet to be determined. This study aimed to investigate IHC markers in the prediction of recurrence after SBC resection with adjuvant radiation therapy.The authors reviewed the records of patients who had treatment for SBC between January 2017 and June 2021 across the Mayo Clinic in Minnesota, Florida, and Arizona. Exclusion criteria included patients who had no histopathology or recurrence as an outcome. Histopathological markers included cytokeratin A1/A3 only, epithelial membrane antigen (EMA), S100 protein, pan-cytokeratin, IN1, GATA3, CAM5.2, OSCAR, and chondroid. Information from patient records was abstracted, including treatment, clinical and radiological follow-up duration, demographics, and histopathological factors. Decision tree and random forest classifiers were trained and tested to predict the recurrence based on unseen data using an 80/20 split.A total of 38 patients with a diagnosis of SBC who underwent resection (gross-total resection: 42.1%; and subtotal resection: 57.9%) and radiation therapy were extracted from the medical records. The mean patient age was 48.2 (SD 19.6) years; most patients were male (n = 23; 60.5%) and White (n = 36; 94.7%). Pan-cytokeratin was associated with an increased risk of postoperative recurrence (OR 14.67, 95% CI 2.44-88.13; p = 0.00517) after resection and adjuvant radiotherapy. The decision tree analysis found pan-cytokeratin-positive tumors to have a 78% chance of being classified as a recurrence, with an accuracy of 75%. The distribution of minimal depth in the prediction of postoperative recurrence indicates that the most important variables were pan-cytokeratin, followed by cytokeratin A1/A3 and EMA.The authors' machine learning algorithm identified pan-cytokeratin as the largest contributor to recurrence among other IHC markers after SBC resection. Machine learning may facilitate the prediction of outcomes in rare tumors, such as chordomas.