The epidemiology, surgical management, and impact of margins in skull and mandibular osseous‐site tumors

Abstract

The aim of the study was to characterize the epidemiology and treatment outcomes of head and neck (HN) osseous-site tumors. Methods: Descriptive analyses and multivariate Cox regressions were performed to analyze the effect of surgery on overall survival (OS) utilizing the National Cancer Database (2004-2016). Results: Of 2449 tumors, surgery was utilized in 84.5% of cases. OS was worse in osteosarcoma (5-year OS: 53.4% [SE: 2.5%]) compared with cartilage tumors (5-year OS: 84.6% [SE: 1.8%]) (log-rank P < .001). Treatment regimens that included surgery were associated with improved OS on multivariate analysis (hazard ratio [HR] 0.495 [95% CI: 0.366-0.670]). Positive margins were found in 40.8% of cases, and associated with decreased OS in osteosarcomas (HR 1.304 [0.697-2.438]). Conclusion: Treatment that included surgery was associated with an increased OS within our cohort of HN osseous-site tumors, although the rates of positive margins were >40%. These findings may be limited by inherent selection bias in the database.

Maxillofacial osteosarcoma -- report of two cases with presentation of a two-staged reconstructive strategy and dental rehabilitation

“…In this context, Krishnamurthy et al found positive resection margins as the single important prognostic factor affecting patient survival (14). Although this study contained only 14 patients, Torabi et al analysed a cohort of 2449 osseous tumors of the head and neck region and confirmed association of positive resection margins with decreased OS in the osteosarcoma subgroup (15). These findings underline that effective ablative surgery represents the main therapeutic principle in MOS.…”

Impact of Treatment Modalities upon Survival Outcomes in Skull Base and Clival Chordoma: An NCDB Analysis

“…The use of negative margin status as a surrogate marker for total resection has previously been utilized in analyses of esthesioneuroblastoma, sinonasal mucosal melanoma, osseous-based skull and mandibular tumors, and skull base chondrosarcoma. 9 10 11 12 Clinical covariates included age (<65 or ≥65 years), sex, race (Caucasian, African American, other), presence of comorbidities, year of diagnosis (2004–2009 or 2010–2015), AJCC Analytic Stage (1–2 or 3–4), nodal involvement, metastatic involvement, histology (unspecified, chondroid, or dedifferentiated), and tumor size (<5 or ≥5 cm). Sociodemographic covariates included facility type (academic or nonacademic) and location (east, central, or west), insurance status (private, government, or uninsured), income quartile (<$48,000 or ≥$48,000), education level of residence (<13% or ≥13% without a high school diploma), population size (<250,000 or ≥250,000 individuals), and distance from provider to patient.…”

“…The use of negative margin status as a surrogate marker for total resection has previously been utilized in analyses of esthesioneuroblastoma, sinonasal mucosal melanoma, osseous-based skull and mandibular tumors, and skull base chondrosarcoma. [9][10][11][12] Clinical covariates included age (<65 or ≥65 years), sex, race (Caucasian, African American, Other), presence of comorbidities, year of diagnosis (2004-2009 or 2010-2015), AJCC Analytic Stage (1-2 or 3-4), nodal involvement, metastatic involvement, histology (unspecified, chondroid, or dedifferentiated), and tumor size (<5 or ≥5 cm). Sociodemographic covariates…”