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American Association for Hand Surgery

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Chondrosarcoma of the Upper Extremities: Trending of Tumor Characteristics and Surgical Management
Maria T Huayllani, MD1, Daniel Boczar, MD1, Gabriela Cinotto, MD1, Oscar J Manrique, MD2 and Antonio Jorge Forte, MD1, (1)Mayo Clinic Florida, Jacksonville, FL, (2)Mayo Clinic, Rochester, MN

BACKGROUND: Chondrosarcoma is a rare malignant tumor of cartilage. It represents 3.5-9% of all primary bone tumors. It is commonly found in long bones and has a lower incidence in hand bones reaching 6% of all bone tumors. Our aim is to describe the trending of the tumor characteristics and treatment over the years from 2004 to 2015.

METHODS: A descriptive study was performed to identify the trends in patients with chondrosarcoma of the upper extremities using the National Cancer Database (NCDB) from 2004 to 2015. Moreover, the risk to have amputation versus limb salvage was analyzed. Statistical analysis was performed using Chi-square, univariate and multivariate logistic regression model. P value <0.05 was considered significant.

RESULTS: A total of 1,119 patients diagnosed with chondrosarcoma of the upper extremities met the inclusion criteria. Over time, there has been an increasing number of cases of chondrosarcoma of the upper extremities from 84 in 2004 to 110 in 2015. We found that most of the hand chondrosarcomas are being diagnosed at older ages, while chondrosarcomas of the forearm, arm and shoulder are being diagnosed at younger ages (P<.001). The frequency of tumors with more than 8 cm of size (P=.59) and high grade (P=.16) tended to increase in the last year. Regarding stage, compared to the years between 2004 to 2007, there is a tendency to diagnose these tumors at early stages I and II of disease from 2008 to 2015 (P=.29). Moreover, 45.83% of patients with chondrosarcomas of the upper extremities diagnosed at more advanced stages II and IV did not undergo surgery, compared to only 5.68% of patients with early stages I and II chondrosarcomas that did not have any surgery (P<.001). When compared with limb salvage, patients at older ages (OR, 0.02; CI, 1.01-1.04; P=.01), with tumors located in the hand (OR, 23.92; CI, 10.43-54.83; P<.001), and with tumor size more than 8 cm (OR, 4.44; CI, 1.98-9.96; P<.001) were more likely to undergo amputation. No statistical difference was found for sex, race, comorbidities, year at diagnosis, grade and stage of tumor between these two groups.

CONCLUSION: There has been an increasing number of chondrosarcoma cases of the upper extremities over the years, being diagnosed at early stages despite the tumor presentation at large sizes and high grades. In addition, age, tumor location and size were independent factors that drive the decision of amputation of the compromised upper limb.

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