Survival of Patients With Primary Osseous Malignancies of the Mobile Spine Is Associated With Access to "Standard Treatment" Protocols.

Autor: Stroud SG; 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)., Geiger EJ, Lichtensztajn DY, Goldsby RE, Cheng I, Wustrack R, Theologis AA
Jazyk: angličtina
Zdroj: The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2022 Sep 01; Vol. 30 (17), pp. 841-850. Date of Electronic Publication: 2022 May 03.
DOI: 10.5435/JAAOS-D-22-00072
Abstrakt: Introduction: 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).
Methods: 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.
Results: 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).
Conclusions: 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.
Level of Evidence: III.
(Copyright © 2022 by the American Academy of Orthopaedic Surgeons.)
Databáze: MEDLINE