Association of surgical resection and survival in patients with malignant primary osseous spinal neoplasms from the Surveillance, Epidemiology, and End Results (SEER) database

Mukherjee, Debraj; Chaichana, Kaisorn L.; Parker, Scott L.; Gokaslan, Ziya L.; McGirt, Matthew J.

doi:10.1007/s00586-012-2621-4

Cited by 81 publications

(55 citation statements)

References 37 publications

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“…This study also identified that chordomas were more common among Caucasians in both populations, while a higher percentage of pediatric chordoma patients were African American, Hispanic, and Asian/Pacific Islander, compared to adults. These findings are consistent with previous small retrospective studies in which over 80% of chordoma patients were Caucasians [1,6,7,10,11]. …”

Section: Discussionsupporting

confidence: 82%

“…Similar to previously published data, this study identified a higher incidence of chordomas among males in both the pediatric and adult populations [1,7,10,11]. This study also identified that chordomas were more common among Caucasians in both populations, while a higher percentage of pediatric chordoma patients were African American, Hispanic, and Asian/Pacific Islander, compared to adults.…”

Section: Discussionsupporting

confidence: 79%

“…Likewise, York et al [20] studied 27 patients with sacral chordomas over a 40-year period, and reported that recurrence rates with subtotal excision without radiation were 5 times greater than subtotal resection with adjuvant radiation. Finally, Mukherjee et al [10] reported on 215 patients with spinal chordomas and showed a survival advantage for adjuvant radiation compared to surgery alone, with a median survival of 104 months for combination surgery and radiation, compared to 87 months for surgery alone.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Chordomas: A Population-Based Clinical Outcome Study Involving 86 Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1973-2011)

et al. 2016

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Background/Aims: Primary chordomas, rare cancers arising from the notochord remnants, are extremely rare in the pediatric population. This study examined a large cohort of primary chordoma patients to determine factors impacting prognosis and survival. Methods: Demographic and clinical data on 1,358 primary chordoma patients (86 pediatric patients ≤19 years of age and 1,272 adult patients ≥20 years of age) were abstracted from the Surveillance, Epidemiology, and End Result (SEER) database (1973-2011). Results: Pediatric primary chordomas present most often as small tumors <4 cm in the cranium of male Caucasians. Despite the majority of primary chordomas presenting with locoregional involvement (90.4%), pediatric patients had more distant disease (14.8 vs. 9.2%, p < 0.05). Survival among pediatric patients having surgery only was significantly longer than for adults (22.5 vs. 14.3 years, p < 0.001). Overall survival was longer (17.2 vs. 12.6 years) and overall mortality was lower in pediatric patients (38.4 vs. 49.8%), but cancer-specific mortality was higher (37.2 vs. 28.6%, p < 0.005). Conclusions: Pediatric primary chordomas present most often as small tumors <4 cm in the cranium of male Caucasians. Despite having a higher rate of metastasis, they have prolonged survival compared to adults. Surgical resection significantly improves survival in pediatric primary chordoma patients, and should be considered as first-line therapy in all eligible children.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Pediatric Chordomas: A Population-Based Clinical Outcome Study Involving 86 Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1973-2011)

et al. 2016

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“…1,13,14,16,17,26,27,30,31,38,63,93,[95][96][97][98] However, surgical approaches to spinal tumors often necessitate extensive reconstruction of the spinal column and may require adjuvant chemotherapy or radiation; therefore, perioperative complication rates after spinal tumor surgery are higher than in other spinal operations. [34][35][36][46][47][48]50,52,65,67,68,78,80,81,[86][87][88]95,100 It is especially important to understand the incidence and predictive factors for adverse events in spinal oncology patients, as a single complication may be associated with morbidity, mortality, and costs. 1,31,37,46,47,52,62,70,72,79,86,95 Risk stratification of patients preoperatively is important to optimize outcomes, …”

mentioning

confidence: 99%

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Karhade

Vasudeva

Dasenbrock

et al. 2016

FOC

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OBJECTIVE The goal of this study was to use a large national registry to evaluate the 30-day cumulative incidence and predictors of adverse events, readmissions, and reoperations after surgery for primary and secondary spinal tumors. METHODS Data from adult patients who underwent surgery for spinal tumors (2011–2014) were extracted from the prospective National Surgical Quality Improvement Program (NSQIP) registry. Multivariable logistic regression was used to evaluate predictors of reoperation, readmission, and major complications (death, neurological, cardiopulmonary, venous thromboembolism [VTE], surgical site infection [SSI], and sepsis). Variables screened included patient age, sex, tumor location, American Society of Anesthesiologists (ASA) physical classification, preoperative functional status, comorbidities, preoperative laboratory values, case urgency, and operative time. Additional variables that were evaluated when analyzing readmission included complications during the surgical hospitalization, hospital length of stay (LOS), and discharge disposition. RESULTS Among the 2207 patients evaluated, 51.4% had extradural tumors, 36.4% had intradural extramedullary tumors, and 12.3% had intramedullary tumors. By spinal level, 20.7% were cervical lesions, 47.4% were thoracic lesions, 29.1% were lumbar lesions, and 2.8% were sacral lesions. Readmission occurred in 10.2% of patients at a median of 18 days (interquartile range [IQR] 12–23 days); the most common reasons for readmission were SSIs (23.7%), systemic infections (17.8%), VTE (12.7%), and CNS complications (11.9%). Predictors of readmission were comorbidities (dyspnea, hypertension, and anemia), disseminated cancer, preoperative steroid use, and an extended hospitalization. Reoperation occurred in 5.3% of patients at a median of 13 days (IQR 8–20 days) postoperatively and was associated with preoperative steroid use and ASA Class 4–5 designation. Major complications occurred in 14.4% of patients: the most common complications and their median time to occurrence were VTE (4.5%) at 9 days (IQR 4–19 days) postoperatively, SSIs (3.6%) at 18 days (IQR 14–25 days), and sepsis (2.9%) at 13 days (IQR 7–21 days). Predictors of major complications included dependent functional status, emergency case status, male sex, comorbidities (dyspnea, bleeding disorders, preoperative systemic inflammatory response syndrome, preoperative leukocytosis), and ASA Class 3–5 designation (p < 0.05). The median hospital LOS was 5 days (IQR 3–9 days), the 30-day mortality rate was 3.3%, and the median time to death was 20 days (IQR 12.5–26 days). CONCLUSIONS In this NSQIP analysis, 10.2% of patients undergoing surgery for spinal tumors were readmitted within 30 days, 5.3% underwent a reoperation, and 14.4% experienced a major complication. The most common complications were SSIs, systemic infections, and VTE, which often occurred late (after discharge from the surgical hospitalization). Patients were primarily readmitted for new complications that developed following discharge rather than exacerbation of complications from the surgical hospital stay. The strongest predictors of adverse events were comorbidities, preoperative steroid use, and higher ASA classification. These models can be used by surgeons to risk-stratify patients preoperatively and identify those who may benefit from increased surveillance following hospital discharge.

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“…3 Additionally, patients who undergo surgery are also thought to demonstrate improved survival. 17 However, the optimal method of local control in spinal disease remains to be indeterminate. This is in part because of methodological challenges related to low patient numbers, selection bias, lack of standardized outcome reporting across studies, and no standardized treatment methods for local control.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of en bloc resection in the management of Ewing’s Sarcoma of the mobile spine with respect to local control and disease free survival

et al. 2015

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Association of surgical resection and survival in patients with malignant primary osseous spinal neoplasms from the Surveillance, Epidemiology, and End Results (SEER) database

Cited by 81 publications

References 37 publications

Pediatric Chordomas: A Population-Based Clinical Outcome Study Involving 86 Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1973-2011)

Pediatric Chordomas: A Population-Based Clinical Outcome Study Involving 86 Patients from the Surveillance, Epidemiology, and End Result (SEER) Database (1973-2011)

Thirty-day readmission and reoperation after surgery for spinal tumors: a National Surgical Quality Improvement Program analysis

Systematic review of en bloc resection in the management of Ewing’s Sarcoma of the mobile spine with respect to local control and disease free survival

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