Impact of nodal involvement on survival outcomes in chondrosarcoma: retrospective cohort analysis of Surveillance, Epidemiology, and End Results (SEER) database (2004–2015)

L. Cranmer, Bonny Chau, Matthew J. Thompson, E. Loggers, S. Pollack, M. Wagner, Teresa S. Kim, Edward Y. Kim, G. Kane, G. Pavey
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引用次数: 1

Abstract

Supplemental Digital Content is available in the text. Objectives: Factors associated with nodal involvement in chondrosarcoma and outcomes based on treatment modality were analyzed using the Surveillance, Epidemiology, and End Results (SEER) database. Methods: Chondrosarcomas involving axial and appendicular parts of the body diagnosed from 2004 to 2015 were identified in SEER. Clinical, pathologic, and treatment parameters were compared with respect to nodal status at initial diagnosis by Fisher’s exact or Student’s t-test. Disease-specific survival (DSS) and overall survival (OS) were evaluated by Kaplan-Meier analyses, and by Cox regression models. Results: Synchronous regional nodal metastases were present in 1.3% of chondrosarcoma patients. Lymph node involvement was associated with primary tumor location in extraskeletal tissue and the pelvis, and with distant metastasis and larger primary tumor size at diagnosis. Patients with nodal involvement had 5-year DSS of 48% [95% confidence interval (CI): 28%–65%], versus 82% (95% CI: 80%–84%) for those without (log-rank P<0.001). 5-year OS with and without nodal involvement were 38% (95% CI: 21%–55%) and 73% (95% CI: 71%–75%), respectively (log-rank P<0.001). Surgical excision of nodes was associated with improved DSS and OS. Radiation and chemotherapy were not associated with improved DSS/OS. Conclusions: The nodal disease is uncommon at presentation in chondrosarcoma. Greater clinical vigilance for regional nodal metastases may be warranted for those with specific risk factors, including extraskeletal or pelvic primary sites, myxoid, mesenchymal, or dedifferentiated histologies, and large size. Surgical excision of regional nodes is associated with improved DSS/OS. This analysis suggests a therapeutic effect of surgical treatment, rather than selection for favorable underlying biological factors.
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结节累及对软骨肉瘤生存结局的影响:监测、流行病学和最终结果(SEER)数据库(2004-2015)的回顾性队列分析
补充数字内容可在文本中找到。目的:利用监测、流行病学和最终结果(SEER)数据库分析与软骨肉瘤淋巴结累及相关的因素和基于治疗方式的结果。方法:对2004 ~ 2015年诊断的累及身体轴尾部分的软骨肉瘤进行SEER鉴别。通过Fisher精确或Student t检验比较临床、病理和治疗参数在初始诊断时的淋巴结状态。通过Kaplan-Meier分析和Cox回归模型评估疾病特异性生存期(DSS)和总生存期(OS)。结果:1.3%的软骨肉瘤患者存在同步区域淋巴结转移。淋巴结受累与原发肿瘤位于骨骼外组织和骨盆、远处转移和诊断时原发肿瘤较大有关。淋巴结受累患者的5年DSS为48%[95%可信区间(CI): 28%-65%],而无淋巴结受累患者的5年DSS为82% (95% CI: 80%-84%) (log-rank P<0.001)。有无淋巴结受累的5年OS分别为38% (95% CI: 21%-55%)和73% (95% CI: 71%-75%) (log-rank P<0.001)。手术切除淋巴结与改善DSS和OS相关。放疗和化疗与改善DSS/OS无关。结论:软骨肉瘤的淋巴结病变在临床表现上并不常见。对于那些有特定危险因素的患者,包括骨外或盆腔原发灶、粘液样、间充质或去分化组织学,以及体积较大的患者,可能需要提高对局部淋巴结转移的临床警惕性。手术切除局部淋巴结可改善DSS/OS。这一分析表明手术治疗的治疗效果,而不是有利的潜在生物学因素的选择。
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