Association of surgical resection and survival in patients with malignant primary osseous spinal neoplasms from the Surveillance, Epidemiology, and End Results (SEER) database

Abstract

Objective: Malignant osseous spinal neoplasms are aggressive tumors associated with poor outcomes despite aggressive multidisciplinary measures. While surgical resection has been shown to improve short-term local disease control, it remains debated whether surgical resection is associated with improved overall survival in patients with malignant primary osseous spinal neoplasms. The aim of this manuscript is to review survival data from a US cancer registry spanning 30 years to determine if surgical resection was independently associated with overall survival.

Methods: The SEER registry (1973-2003) was queried to identify cases of histologically confirmed primary spinal chordoma, chondrosarcoma, osteosarcoma, or Ewing's sarcoma of the mobile spine and pelvis. Patients with systemic metastasis were excluded. Age, gender, race, tumor location, and primary treatments were identified. Extent of local tumor invasion was classified as confined within periosteum versus extension beyond periosteum to surrounding tissues. The association of surgical resection with overall survival was assessed via Cox analysis adjusting for age, radiotherapy, and tumor invasiveness.

Results: 827 patients were identified with non-metastatic primary osseous spinal neoplasms (215 chordoma, 282 chondrosarcoma, 158 osteosarcoma, 172 Ewing's sarcoma). Overall, median survival was histology specific (chordoma, 96 months; Ewing's sarcoma, 90 months; chondrosarcoma, 88 months; osteosarcoma, 18 months). Adjusting for age, radiation therapy, and extent of local tumor invasion in patients with isolated (non-metastatic) spine tumors, surgical resection was independently associated with significantly improved survival for chordoma [hazard ratio (95 % confidence interval; 0.617 (0.25-0.98)], chondrosarcoma [HR (95 %CI); 0.153 (0.07-0.36)], osteosarcoma [HR (95 %CI); 0.382 (0.21-0.69)], and Ewing's sarcoma [HR (95 %CI); 0.494 (0.26-0.96)].

Conclusion: In our analysis of a 30-year US population-based cancer registry (SEER), patients undergoing surgical resection of primary spinal chordoma, chondrosarcoma, Ewing's sarcoma, or osteosarcoma demonstrated prolonged overall survival independent of patient age, extent of local invasion, or location. Surgical resection may play a role in prolonging survival in the multi-modality treatment of patients with these malignant primary osseous spinal neoplasms.

Fig. 1

Kaplan–Meier estimated survival in patients with primary osseous spinal tumors a chordoma, b chondrosarcoma, c osteosarcoma, or d Ewing’s sarcoma stratified by surgical resection versus no surgery. Adjusting for age, radiation therapy, and extent of local tumor invasion in patients with isolated (non-metastatic) spine tumors, surgical resection was associated with significantly improved survival for chordoma [Hazard Ratio (95 % confidence interval; 0.617 (0.25–0.98)], chondrosarcoma [HR (95 %CI); 0.153 (0.07–0.36)], osteosarcoma [HR (95 %CI); 0.382 (0.21–0.69)], and Ewing’s sarcoma [HR (95 %CI); 0.494 (0.26–0.96)]

Fig. 2

Kaplan–Meier estimated survival in patients with primary osseous spinal tumors that were: a confined (tumor confined to cortex of bone or extension beyond cortex but confined within periosteum) or b locally invasive (extension beyond periosteum to surrounding tissues, including adjacent skeletal muscle, adjacent bone/cartilage, or skin). Surgery was associated with increased survival for both primary spinal tumors that were confined (p < 0.01) or locally invasive (p < 0.001)

Fig. 3

Kaplan–Meier estimated survival in patients with primary osseous spinal tumors that were located a in the mobile spine or b the sacrum/pelvis. Surgery was associated with increased survival for both primary tumors located in the mobile spine (p < 0.05) as well as those located in the sacrum/pelvis (p < 0.001)