Authors: Brian A Schneiderman Stephanie A Kliethermes Lukas M Nystrom
Publish Date: 2016/03/14
Volume: 475, Issue: 3, Pages: 799-805
Abstract
Studies suggest that mesenchymal chondrosarcoma is associated with a poorer prognosis and a higher proportion of extraskeletal tumors than conventional chondrosarcoma However these investigations have been small heterogeneous cohorts limiting analysis of prognostic factorsThe Surveillance Epidemiology and End Results SEER database was used to identify all patients diagnosed with mesenchymal chondrosarcoma from 1973 to 2011 SEER reports survival data on over 82 million patients with cancer and has attained 98 completeness in reporting Using variables within the database this study designated each patient’s tumor as skeletal or extraskeletal and cranial axial or appendicular respectively Overall survival OS was determined for the entire series as well as each group Median survival was calculated using KaplanMeier methods Cox proportional hazards regression was used to determine whether demographic and tumor variables affected survival Two hundred five patients with mesenchymal chondrosarcoma were identified including 82 40 skeletal and 123 60 extraskeletalOS for the entire series was 51 95 confidence interval CI 43–58 and 43 95 CI 35–51 at 5 and 10 years respectively No difference in OS was detected between extraskeletal and skeletal tumors KaplanMeier analyses showed OS was worse for tumors in axial locations compared with appendicular and cranial locations Appendicular tumors demonstrated an OS of 50 95 CI 36–63 at 5 years and 39 95 CI 26–52 at 10 years OS for axial tumors was 37 95 CI 25–49 and 31 95 CI 20–43 whereas it was 74 95 CI 59–84 and 67 95 CI 50–79 for cranial tumors at 5 and 10 years respectively When controlling for age sex tumor origin and tumor location the presence of metastasis hazard ratio HR 1238 95 CI 575–2665 p 0001 and 1cm size increase HR 116 95 CI 109–123 p 0001 were both independently associated with an increased risk of death Tumor location showed different behaviors depending on patient age In comparison to cranial tumors at age 20 years the HR was 556 95 CI 147–2105 p = 001 for axial tumors and 626 95 CI 154–2542 p = 001 for appendicular tumors At age 60 years those ratios were 010 95 CI 002–055 p = 001 and 014 95 CI 004–058 p = 001 respectivelyOur data suggest that extraskeletal tumors are more common than previously reported however this factor does not have clear prognostic value Presence of metastatic disease and increased tumor size are the main predictors of poor survival outcome Cranial tumors appear to have a different clinical behavior with our data suggesting better overall survival in young patients compared with axial and appendicular locations and a worse survival outcome in older patientsEach author certifies that he or she or a member of his or her immediate family has no funding or commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted article
Keywords: