From the Department of Orthopedic Surgery, University of California-San Francisco (UCSF) (Stroud, Geiger, Wustrack, and Theologis), the Department of Epidemiology and Biostatistics, UCSF (Lichtensztajn, and Cheng), and the Department of Pediatric Hematology-Oncology, UCSF, San Francisco, CA (Goldsby).
J Am Acad Orthop Surg. 2022 Sep 1;30(17):841-850. doi: 10.5435/JAAOS-D-22-00072. Epub 2022 May 3.
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).
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.
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).
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.
III.
移动脊柱的恶性肿瘤具有很高的发病率和死亡率。本研究旨在探讨加利福尼亚癌症登记处（CCR）中原发性移动脊柱肿瘤患者接受“标准”治疗和生存的相关因素。
从 CCR（1988 年至 2016 年）数据中获取至少有 1 年随访的原发性脊柱肿瘤患者的资料。排除骶骨/骨盆肿瘤。收集患者的年龄、性别、种族、社区社会经济地位、保险状况、Charlson 合并症指数、组织学诊断、诊断时的分期和在国立癌症研究所指定癌症中心（NCICC）的治疗情况。进行多变量分析以确定与全因死亡率和接受“标准”治疗相关的因素。
共纳入 484 例患者（64%为白人，56%社区社会经济地位较低，36%为私人保险）。脊索瘤（37%）是最常见的诊断。仅 16%的患者在就诊时发生转移。仅 29%的患者在 NCICC 接受治疗。较低的年龄、Charlson 合并症指数、疾病的分期较局限以及私人保险与较低的全因死亡率相关（均 P<0.05）。与私人保险相比，医疗补助/公共保险（危险比[HR]，1.65；95%置信区间[CI]，1.13 至 2.41）和医疗保险（HR，1.80；95%CI，1.25 至 2.59）与较高的死亡率相关。未接受任何已知治疗（HR，2.41；CI，1.51 至 3.84）或接受非“标准”治疗（HR，1.45；CI，1.11 至 1.91）的患者死亡率高于接受标准方案的患者。接受标准治疗方案的关键预测因素是在 NCICC 接受治疗。如果患者不在此类机构接受治疗，他们只有 40%的时间接受最佳治疗（HR，0.5；P=0.004）。
在接受原发性移动脊柱骨恶性肿瘤治疗的患者中，接受明确的“标准治疗”方案与在 NCICC 接受治疗和全因死亡率降低相关。无论年龄、疾病负担或接受标准治疗，接受公共保险的患者都容易出现更差的结局。
III。
