Importantly, patients who had recurrent and metastatic chordomas prior to surgery showed significantly higher cyclin E1 expression compared to those patients with primary lesions (recurrence versus primary, 2.1 ± 1.1 versus 1.4 ± 0.9, P=0.006; metastasis versus primary, 2.6 ± 0.5 versus 1.4 ± 0.9, P=0.012) (Figure 3E). This evidence concerns the gene CCNE1 and chordoma.