Survival of Patients With Primary Osseous Malignancies of the Mobile Spine Is Associated With Access to “Standard Treatment” Protocols

Abstract

Introduction:Malignancies of the mobile spine carry high morbidity and mortality. This study sought to examine factors associated with receipt of “standard” treatment and survival for patients with primary mobile spine tumors in the California Cancer Registry (CCR).Methods:The CCR (1988 to 2016) data were obtained for patients with primary tumors of the mobile spine and at least 1-year follow-up. Sacrum/pelvis tumors were excluded. Age at diagnosis, sex, race, neighborhood socioeconomic status, insurance, Charlson Comorbidity Index, histologic diagnosis, stage at diagnosis, and treatment at a National Cancer Institute-designated Cancer Center (NCICC) were collected. Multivariate analyses were done to identify factors associated with all-cause mortality and receipt of “standard” treatment.Results:Four hundred eighty-four patients (64% White, 56% low neighborhood socioeconomic status, and 36% privately insured) were included. Chordoma (37%) was the most common diagnosis. Only 16% had metastatic disease at presentation. Only 29% received treatment at an NCICC. Lower age, Charlson Comorbidity Index, less extensive stage of disease, and private insurance were associated with lower all-cause mortality (all P < 0.05). Medicaid/public insurance (hazard ratio [HR], 1.65; 95% confidence interval [CI], 1.13 to 2.41) and Medicare (HR, 1.80; 95% CI, 1.25 to 2.59) were associated with higher mortality compared with private insurance. Patients who received no known treatment (HR, 2.41; CI, 1.51 to 3.84) or treatment other than the “standard” (HR, 1.45; CI, 1.11 to 1.91) had higher mortality compared with those who received the standard protocols. A critical predictor of receiving the standard treatment protocol was being treated at an NCICC. If patients did not receive care at such institutions, they received optimal treatment only 40% of the time (HR, 0.5; P = 0.004).Conclusions:Receipt of defined “standard treatment” protocols was associated with care received at an NCICC and lower all-cause mortality in patients with primary osseous malignancies of the mobile spine. Patients with public insurance are vulnerable to worse outcomes, regardless of age, disease burden, or receipt of standard treatment.Level of evidence:III

What’s New in Musculoskeletal Tumor Surgery

“…However, the authors found that surgical resection was beneficial in preventing new neurologic deficits. Similarly, through the California Cancer Registry, Stroud et al evaluated patients with primary bone malignancies of the mobile spine 29 . Patients who underwent standard treatment had lower mortality rates when compared with patients who did not undergo any known treatment.…”

What’s New in Musculoskeletal Tumor Surgery

“…The National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, the American College of Surgeons (ACS) National Cancer Database, and the California Cancer Registry were queried by several authors who concluded that radiation therapy is the most common local modality used in the United States for Ewing sarcoma of the sacrum or pelvis and has similar efficacy to surgical resection with or without radiation therapy; that 5-year disease-specific survival in patients with mobile vertebral column sarcomas was 56%, with worse survival for osteosarcoma; and that patients with malignancies of the mobile spine with public insurance are vulnerable to worse outcomes, even if they receive standard treatment 6,9,11 .…”

“…A few studies have identified risk factors for poorer oncologic and surgical outcomes in pelvic tumors. These include a venous tumor thrombus, a margin of <2 mm, complete acetabular resection compared with transacetabular resection, and sarcopenia 1,3,7,8 .The National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, the American College of Surgeons (ACS) National Cancer Database, and the California Cancer Registry were queried by several authors who concluded that radiation therapy is the most common local modality used in the United States for Ewing sarcoma of the sacrum or pelvis and has similar efficacy to surgical resection with or without radiation therapy; that 5-year disease-specific survival in patients with mobile vertebral column sarcomas was 56%, with worse survival for osteosarcoma; and that patients with malignancies of the mobile spine with public insurance are vulnerable to worse outcomes, even if they receive standard treatment 6,9,11 .Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H270).…”