Incidence, Management, and Outcomes of Adult Spinal Chondrosarcoma Patients in the United States.

OBJECTIVE Spinal chondrosarcomas are rare primary malignant neoplasms composed of cartilage-producing cells. They are slow growing but locally aggressive lesions that have high rates of recurrence and progression after treatment. Here we provide the largest comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in spinal chondrosarcoma patients using a large, prospectively-collected national database. METHODS Patients with diagnosis codes specific for chondrosarcoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. RESULTS 1,843 individuals were identified with a diagnosis of chondrosarcoma, 82.1% of which were at the sacrum or coccyx and 17.9% at the spine. The mean overall survival of patients in our cohort was 7.91 years. Increased age, larger tumor size, dedifferentiated histology, and presence of metastases were associated with worsened overall survival. In regards to management, 77.7% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival (P<0.001). Neither radiotherapy or chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received higher-dose radiation had significantly improved overall survival compared to lower-dose radiation. CONCLUSION Surgical resection significantly improves overall survival in patients with spinal chondrosarcoma. In those patients receiving radiation, those who receive high doses have improved overall survival compared to those who receive lower doses. Further studies into optimal radiation modality and doses are required.