Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Orthopedics Surgery, Duke University Medical Center, Durham, NC, USA.
Spine J. 2019 Dec;19(12):1941-1949. doi: 10.1016/j.spinee.2019.07.003. Epub 2019 Jul 12.
Malignant primary spinal tumors are rare making it difficult to perform large studies comparing epidemiologic, survival, and treatment trends. We investigated the largest registry of primary bone tumors, the National Cancer Database (NCDB), to compare epidemiologic and survival trends among these tumors.
To use the NCDB to describe current epidemiologic trends, treatment modalities, and overall survival rates in patients with chordomas, osteosarcomas, chondrosarcomas, and Ewing sarcomas of the mobile spine. The secondary objective was to determine prognostic factors that impact overall survival rates.
Retrospective study.
A total of 1,011 patients with primary bone tumors of the spine (377 chordomas, 223 chondrosarcomas, 278 Ewing sarcomas, and 133 osteosarcomas).
Five-year survival.
We reviewed the records of 1,011 patients in the NCDB from 2004 through 2015 with histologically confirmed primary osteosarcoma, chondrosarcoma, Ewing sarcoma, or chordoma of the spine. Demographic, clinical, and outcomes data were compiled and compared using chi-squared tests and ANOVA. Long-term survival was compared using the Kaplan-Meier method with statistical comparisons based on the log-rank test. Multivariate analysis was performed to determine survival determinants.
Surgical resection was the primary mode of treatment for chondrosarcoma (90%), chordoma (84%), and osteosarcoma (80%). The treatment for Ewing sarcoma was multimodal involving chemotherapy, radiation therapy, and surgical resection. Five-year survival rates varied significantly with chordomas and chondrosarcomas having the greatest survival (70% and 69%), osteosarcomas having the worse survival (38%), and Ewing having intermediate 5-year survival at 62% (overall log-rank p<.0001). Multivariate analysis demonstrated significantly improved 5-year survival rates with younger age at diagnosis, private insurance status, lower comorbidity score, lower tumor grade, smaller tumor size, surgical resection, and negative surgical margin. Radiation therapy only improved survival for Ewing sarcoma.
This study provides the most comprehensive description of the epidemiologic, treatment, and survival trends of primary bone tumors of the mobile spine. Second, patient and tumor characteristics associated with improved 5-year survival were identified using a multivariate model.
原发性脊柱恶性肿瘤较为罕见，因此很难开展大规模研究来比较其流行病学、生存和治疗趋势。我们调查了最大的原发性骨肿瘤登记处——国家癌症数据库（NCDB），以比较这些肿瘤的流行病学和生存趋势。
利用 NCDB 描述脊索瘤、骨肉瘤、软骨肉瘤和尤文肉瘤患者的当前流行病学趋势、治疗方式和总生存率。次要目的是确定影响总生存率的预后因素。
回顾性研究。
共有 1011 例脊柱原发性骨肿瘤患者（377 例脊索瘤、223 例软骨肉瘤、278 例尤文肉瘤和 133 例骨肉瘤）。
5 年生存率。
我们回顾了 2004 年至 2015 年 NCDB 中 1011 例经组织学证实的脊柱原发性骨肉瘤、软骨肉瘤、尤文肉瘤或脊索瘤患者的记录。收集并比较人口统计学、临床和结果数据，使用卡方检验和 ANOVA 进行比较。使用 Kaplan-Meier 方法比较长期生存率，并基于对数秩检验进行统计学比较。进行多变量分析以确定生存决定因素。
手术切除是软骨肉瘤（90%）、脊索瘤（84%）和骨肉瘤（80%）的主要治疗方式。尤文肉瘤的治疗是多模式的，包括化疗、放疗和手术切除。5 年生存率差异显著，脊索瘤和软骨肉瘤的生存率最高（分别为 70%和 69%），骨肉瘤的生存率最差（38%），尤文肉瘤的 5 年生存率居中，为 62%（总体对数秩 p<.0001）。多变量分析显示，诊断时年龄较小、私人保险状态、较低的合并症评分、较低的肿瘤分级、较小的肿瘤大小、手术切除和阴性手术切缘与 5 年生存率显著提高相关。放疗仅能提高尤文肉瘤的生存率。
本研究提供了关于移动脊柱原发性骨肿瘤的最全面的流行病学、治疗和生存趋势描述。其次，使用多变量模型确定了与 5 年生存率提高相关的患者和肿瘤特征。
