Chondrosarcoma of the Osseous Spine: An Analysis of Epidemiology, Patient Outcomes, and Prognostic Factors Using the SEER Registry From 1973 to 2012

Study Design. Retrospective analysis. Objective. To determine the epidemiology and prognostic indicators in patients with chondrosarcoma of the osseous spine. Summary of Background Data. Chondrosarcoma of the spine is rare, with limited data on its epidemiology, clinicopathologic features, and treatment outcomes. Therapy centers on complete en bloc resection with radiotherapy reserved for subtotal resection or advanced disease. Methods. The Surveillance, Epidemiology, and End Results Registry was queried for patients with chondrosarcoma of the osseous spine from 1973 to 2012. Study variables included age, sex, race, year of diagnosis, size, grade, extent of disease, and treatment modality. Results. The search identified 973 cases of spinal chondrosarcoma. Mean age at diagnosis was 51.6 years, and 627% of patients were males. Surgical resection and radiotherapy were performed in 75.2% and 21.3% of cases, respectively. Kaplan-Meier analysis demonstrated overall survival (OS) and disease-specific survival (DSS) of 53% and 64%, respectively, at 5 years. Multivariate Cox regression analysis showed that age (OS, P < 0.001; DSS, P = 0.007), grade (OS, P < 0.001; DSS, P < 0.001), surgical resection (OS, P < 0.001; DSS, P < 0.001), and extent of disease (OS, P < 0.001; DSS, P < 0.001) were independent survival determinants; tumor size was an independent predictor of OS (P = 0.006). For confined disease, age (P = 0.013), decade of diagnosis (P = 0.023), and surgery (P = 0.017) were independent determinants of OS. For locally invasive disease, grade (OS, P < 0.001; DSS, P = 0.003), surgery (OS, P = 0.013; DSS, P = 0.046), and size (OS, P = 0.001, DSS, P = 0.002) were independent determinants of OS and DSS. Radiotherapy was an independent indicator of worse OS for both confined (P = 0.004) and locally invasive disease (P = 0.002). For metastatic disease, grade (OS, P = 0.021; DSS, P = 0.012) and surgery (OS, P = 0.007; DSS, P = 0.004) were survival determinants for both OS and DSS, whereas radiotherapy predicted improved OS (P = 0.039). Conclusion. Surgical resection confers survival benefit in patients with chondrosarcoma of the spine independent of extent of disease. Radiotherapy improves survival in patients with metastatic disease and worsens outcomes in patients with confined and locally invasive disease. Level of Evidence: 4

[1]  L. Kindblom,et al.  Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas , 2001, Cancer.

[2]  W. Curry,et al.  Outcomes and patterns of care in adult skull base chondrosarcomas from the SEER database , 2014, Journal of Clinical Neuroscience.

[3]  Ehud Mendel,et al.  The National Cancer Institute's SEER registry and primary malignant osseous spine tumors. , 2011, World neurosurgery.

[4]  P. Lin,et al.  Does Ifosfamide Therapy Improve Survival of Patients With Dedifferentiated Chondrosarcoma? , 2014, Clinical orthopaedics and related research.

[5]  Ryan M. Stuckey,et al.  Chondrosarcoma of the Mobile Spine and Sacrum , 2011, Sarcoma.

[6]  A. Wilson,et al.  From the archives of the AFIP: imaging of primary chondrosarcoma: radiologic-pathologic correlation. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[7]  T E Schultheiss,et al.  Radiation response of the central nervous system. , 1995, International journal of radiation oncology, biology, physics.

[8]  P. Gerszten,et al.  Radiation for primary spine tumors. , 2008, Neurosurgery clinics of North America.

[9]  Xin Shi,et al.  Prognostic Factors of Patients with Spinal Chondrosarcoma: A Retrospective Analysis of 98 Consecutive Patients in a Single Center , 2014, Annals of Surgical Oncology.

[10]  Joseph H. Schwab,et al.  Chondrosarcoma of the Mobile Spine: A Review of 21 Cases Treated at a Single Center , 2010, Spine.

[11]  Han-Soo Kim,et al.  Long-term Outcome of Chondrosarcoma: A Single Institutional Experience , 2015, Cancer research and treatment : official journal of Korean Cancer Association.

[12]  D. Dahlin,et al.  CHONDROSARCOMA OF BONE--A STUDY OF TWO HUNDRED AND EIGHTY-EIGHT CASES. , 1963, The Journal of bone and joint surgery. American volume.

[13]  W. Hauck,et al.  Proportional hazards (Cox) regression , 1993, Journal of General Internal Medicine.

[14]  K. Unni,et al.  Chondrosarcoma of the spine. , 1989, The Journal of bone and joint surgery. American volume.

[15]  R. Grimer,et al.  Risk factors for survival and local control in chondrosarcoma of bone. , 2002, The Journal of bone and joint surgery. British volume.

[16]  Z. Gokaslan,et al.  Multidisciplinary Management of Primary Tumors of the Vertebral Column , 2009, Current treatment options in oncology.

[17]  Ziya L Gokaslan,et al.  Long-Term Clinical Outcomes Following En Bloc Resections for Sacral Chordomas and Chondrosarcomas: A Series of Twenty Consecutive Patients , 2009, Spine.

[18]  Ziya L Gokaslan,et al.  Preoperative grading scale to predict survival in patients undergoing resection of malignant primary osseous spinal neoplasms. , 2011, The spine journal : official journal of the North American Spine Society.

[19]  A. Bahrami,et al.  Mesenchymal Chondrosarcoma in Children and Young Adults: A Single Institution Retrospective Review , 2015, Sarcoma.

[20]  P. Picci,et al.  Chondrosarcoma of the mobile spine: report on 22 cases. , 2000, Spine.

[21]  L. Koniaris,et al.  Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. , 2009, The Journal of bone and joint surgery. American volume.

[22]  M. Ballo,et al.  Significance of dose in postoperative radiotherapy for soft tissue sarcoma. , 2003, International journal of radiation oncology, biology, physics.

[23]  Debraj Mukherjee,et al.  Association of surgical resection and survival in patients with malignant primary osseous spinal neoplasms from the Surveillance, Epidemiology, and End Results (SEER) database , 2010, European Spine Journal.

[24]  G. Nielsen,et al.  Radiation therapy for control of soft-tissue sarcomas resected with positive margins. , 2005, International journal of radiation oncology, biology, physics.

[25]  Han-Soo Kim,et al.  Oncologic outcome after local recurrence of chondrosarcoma: Analysis of prognostic factors , 2015, Journal of surgical oncology.

[26]  P. Brown,et al.  Postoperative Proton Therapy for Chordomas and Chondrosarcomas of the Spine: Adjuvant Versus Salvage Radiation Therapy , 2015, Spine.

[27]  Jean-Paul Wolinsky,et al.  Epidemiologic, functional, and oncologic outcome analysis of spinal sarcomas treated surgically at a single institution over 10 years. , 2015, The spine journal : official journal of the North American Spine Society.

[28]  F. Bertucci,et al.  Advanced chondrosarcomas: role of chemotherapy and survival. , 2013, Annals of oncology : official journal of the European Society for Medical Oncology.

[29]  Joseph S. Cheng,et al.  Association of extent of local tumor invasion and survival in patients with malignant primary osseous spinal neoplasms from the surveillance, epidemiology, and end results (SEER) database. , 2011, World neurosurgery.

[30]  J. Buckwalter,et al.  Estimated Cause-specific Survival Continues to Improve Over Time in Patients With Chondrosarcoma , 2014, Clinical orthopaedics and related research.

[31]  Ziya L Gokaslan,et al.  Survival of patients with malignant primary osseous spinal neoplasms: results from the Surveillance, Epidemiology, and End Results (SEER) database from 1973 to 2003. , 2011, Journal of neurosurgery. Spine.

[32]  B. Davies,et al.  Radiation-Induced Dedifferentiated Chondrosarcoma With Orbital Invasion , 2014, Ophthalmic plastic and reconstructive surgery.

[33]  G. Gallia,et al.  En bloc resection of primary sacral tumors: classification of surgical approaches and outcome. , 2005, Journal of neurosurgery. Spine.

[34]  J. Coresh,et al.  Adjusting survival curves for confounders: a review and a new method. , 1996, American journal of epidemiology.

[35]  G. Rosen,et al.  Primary malignant tumors of the spine. , 2009, The Orthopedic clinics of North America.

[36]  S Gitelis,et al.  Chondrosarcoma of bone. The experience at the Istituto Ortopedico Rizzoli. , 1981, The Journal of bone and joint surgery. American volume.