Understanding Survival, Prognostic Factors and Treatment Patterns for Malignant Bone Sarcomas of the Hand: A National Cancer Database Analysis
Azeem Tariq Malik, MBBS1, Annie Chen, MSc2, Thomas Utset-Ward, MD1, Thomas Scharschmidt, MD1, Joel Mayerson, MD3, Carl Quinion, MD1 and John H Alexander, MD1, (1)The Ohio State University Wexner Medical Center, Columbus, OH, (2)The Ohio State University College of Medicine, Columbus, OH, (3)Orthopedic Surgery, Ohio State University, Columbus, OH
Given the relatively rare occurrence, little is known about the overall survival/prognosis and treatment patterns of malignant bone sarcomas of the hand. The purpose of this study was to utilize a large nationally validated cancer database to better understand the overall survival, prognostic factors, and treatment patterns in care for patients with malignant bone sarcomas of the hand.
This was a retrospective review of nationally validated data from the 2004 to 2019 National Cancer Database (NCDB). Primary site code C40.1 was used to identify patients with malignant bone sarcomas of the hand, involving carpus and distal to carpus. Histology codes were used to categorize patients. Descriptive analysis was used to report treatment patterns for these patients. Kaplan-Meier survival analysis was used to report the overall survival of the cohort, as well as histology-stratified subsets. Cox-regression analysis was used to report factors associated with worse overall survival.
This study consists of 527 patients with malignant bone sarcomas of the hand. The most common histologic types were chondrosarcoma (N=261; 49.5%), followed by osteosarcoma (N=102; 19.4%), Ewing sarcoma (N=54; 10.2%) and malignant giant cell tumors (N=40; 7.6%). Majority of patients received care at Academic centers (N=205; 38.9%), however, 29% (N=153) patients were referred from other places. The median tumor size at presentation was 5.20cm. Surgical resection was performed in nearly 88% (N=461) of patients, with 36% (N=116) receiving radical resections with salvage, and 25% (N=25) receiving amputation. Around 26% (N=135) of patients received chemotherapy and 9.5% (N=50) received radiation as part of the treatment. Around 7% (N=38) patients had metastatic disease at diagnosis. The overall 5-year survival and 10-year survival for the entire cohort was 82% and 72%. When stratified by histology, 5-year survival rate for each histologic type was as follows: osteosarcoma â€“ 68%, chondrosarcoma â€“ 84%, Ewing â€“ 85%. Cox-Hazard regression modeling showed that having Medicare insurance (HR 2.36 [95% CI 1.16-4.80]; p=0.017), Stage IV disease at presentation (HR 4.73 [95% 1.26-17.81]; p=0.022) and positive surgical margins (HR 2.74 [95% CI 1.25-6.07]; p=0.012) were associated with poor overall survival, whereas local resection/partial resection (HR 0.31 [95% CI 0.12-0.78]; p=0.012) and a histologic diagnosis of chondrosarcoma (HR 0.43 [95% CI 0.20-0.93]; p=0.032) were associated with better overall survival.
Based on a review of national validated cancer data, findings of this study shed light on the overall prognosis of malignant bone sarcomas of the hand, and associated treatment/care patterns that influence survival.
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