Introduction: Primary osseous spinal neoplasms are aggressive tumors associated with poor outcomes. However, it remains unknown whether a patient's race is associated with overall survival, as in other primary malignancies.
Methods: The SEER registry (1973-2005) was queried to identify histologically confirmed cases of chondrosarcoma, chordoma, Ewing sarcoma, or osteosarcoma. Race was classified as Caucasian, African-American, Native American, or Asian. The association of race with survival was assessed by Chi-square tests, Kaplan-Meier estimates, and log-rank tests (p-value <0.05 considered statistically significant).
Results: 1892 patients were identified (579 chondrosarcomas; 414 chordomas; 469 Ewing sarcomas; 430 osteosarcomas). Median survival was histology specific (chondrosarcoma 37 months; chordoma 50 months, Ewing's sarcoma 26 months; osteosarcoma 11 months). Causians, African-Americans, Asians, and Native Americans accounted for 88.8%, 4.9%, 4.9%, 0.6% of all patients, respectively.
Median survival varied by tumor type and race. Chondrosarcoma median survival ranged from 1 month (Native Americans) to 262 months (African-Americans), chordoma median survival ranged from 23 months (Native Americans) to 104 months (African-Americans), Ewing sarcoma median survival ranged from 23 months (Asians) to 41 months (Native Americans), and osteosarcoma median survival ranged from 4 months (Native Americans) to 13 months (African-Americans). Chi-square testing demonstrated race was significantly associated with survival only within the Ewing sarcoma subset (p=0.048). Similarly, Kaplan-Meier estimates and log-rank testing of 5-year survival only demonstrated a significant assocIation between race and survival within the Ewing sarcoma subset (p=0.041).
Conclusions: Variation exists in the survival patterns of patients with subtypes of primary osseous spinal neosplasms. These differences appear to track along racial lines, most significantly within the Ewing sarcoma subset. Interestingly, some minority groups had significantly better survival than Caucasians, while other minorities consistenly had worse survival than Caucasian counterparts. Further investigation is necessary to determine the mechanisms underlying these significant differences in patient survival.
Patient Care: Disparities in healthcare and variations in patient outcomes have been well-document throughout the medical literature but have been only incompletely described within the neurosurgical literature. This study documents the significantly variable survival patterns seen in over 1500 patients with primary osseous spinal neoplasms. By identifying race as a significant factor in overall survival for some such tumors, this study focuses the clinican and the policymaker upon patient race as a potential area in which we may still be able to investigate biological mechanisms or health policy solutions aimed at reducing such survival disparities in the years ahead.
Learning Objectives: By the conclusion of this session, participants should be able to:
1. Detail the varying survival patterns of patients with primary osseous spinal neoplasms.
2. Describe the complex relationship between tumor type and race upon median and overall survival in patients with chondrosarcoma, chordoma, Ewing sarcoma, and osteosarcoma.
3. Explore some of the mechanisms thought to explain the greater survival seen in multiple minorities groups with varying forms of primary osseous spinal neoplasms, relative to Caucasians.