Survival of patients with malignant primary osseous spinal neoplasms: results from the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2003

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Malignant primary osseous spinal neoplasms are aggressive tumors that remain associated with poor outcomes despite aggressive multidisciplinary treatment measures. To date, prognosis for patients with these tumors is based on results from small single-center patient series and controlled trials. Large population-based observational studies are lacking. To assess national trends in histology-specific survival, the authors reviewed patient survival data spanning 30 years (1973–2003) from the Surveillance, Epidemiology, and End Results (SEER) registry, a US population-based cancer registry.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The SEER registry was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing sarcoma using coding from the International Classification of Disease for Oncology, Third Edition. Association of survival with histology, metastasis status, tumor site, and year of diagnosis was assessed using Cox proportional-hazards regression analysis.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 1892 patients were identified with primary osseous spinal neoplasms (414 with chordomas, 579 with chondrosarcomas, 430 with osteosarcomas, and 469 with Ewing sarcomas). Chordomas presented in older patients (60 ± 17 years; p &lt; 0.01) whereas Ewing sarcoma presented in younger patients (19 ± 11 years; p &lt; 0.01) compared with patients with all other tumors. The relative incidence of each tumor type remained similar per decade from 1973 to 2003. African Americans comprised a significantly greater proportion of patients with osteosarcomas than other tumors (9.6% vs 3.5%, respectively; p &lt; 0.01). Compared with the sacrum, the mobile spine was more likely to be the site of tumor location for chordomas than for all other tumors (47% vs 23%, respectively; p &lt; 0.05). Osteosarcoma and Ewing sarcoma were 3 times more likely than chondrosarcoma and chordoma to present with metastasis (31% vs 8%, respectively). Resection was performed more frequently for chordoma (88%) and chondrosarcoma (89%) than for osteosarcoma (61%) and Ewing sarcoma (53%). Overall median survival was histology-specific (osteosarcoma, 11 months; Ewing sarcoma, 26 months; chondrosarcoma, 37 months; chordoma, 50 months) and significantly worse in patients with metastasis at presentation for all tumor types. Survival did not significantly differ as a function of site (mobile spine vs sacrum/pelvis) for any tumor type, but more recent year of diagnosis was associated with improved survival for isolated spinal Ewing sarcoma (hazard ration [HR] 0.95; p = 0.001), chondrosarcoma (HR 0.98; p = 0.009), and chordoma (HR 0.98; p = 0.10), but not osteosarcoma.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>In this analysis of a 30-year, US population-based cancer registry (SEER), the authors provide nationally representative prognosis and survival data for patients with malignant primary spinal osseous neoplasms. Overall patient survival has improved for isolated spine tumors with advancements in care over the past 4 decades. These results may be helpful in providing historical controls for understanding the efficacy of new treatment paradigms, patient education, and guiding level of aggressiveness in treatment strategies.</jats:p></jats:sec>

Surgical treatment of primary malignant tumors of the sacrum

“…According to the results of large scale population registries, the incidence of primary sacral tumors varies between 32% and 71% of all primary spinal tumors 10,11 . The most common primary malignant tumors of the sacrum are chordoma and sacral sarcomas like chondrosarcoma, osteosarcoma and Ewing sarcoma 12 .…”

Image-guided resection of aggressive sacral tumors

“…Its ability to halt growth of tumor has been described. [72][73][74] Lackman et al 58 reported on 5 cases of sacral GCT treated solely with recurrent arterial embolization, with 4 demonstrating no growth or recurrence. Intralesional curettage is the mainstay of treatment in long bones and is often combined with local adjuvants such as cryotherapy, peroxide, ethanol, phenol, and bone cement to reduce recurrence.…”

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

“…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, …”