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Does Resection of the Primary Tumor Improve Survival in Patients With Metastatic Chondrosarcoma?

Song, Kehan, MD; Song, Jian, MD; Chen, Feiyan, MD; Lin, Kaiyuan, MD; Ma, Xiaosheng, PhD; Jiang, Jianyuan, MD

Clinical Orthopaedics and Related Research®: March 2019 - Volume 477 - Issue 3 - p 573–583
doi: 10.1097/CORR.0000000000000632
CLINICAL RESEARCH
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Background Although surgical resection or amputation has been the mainstay of localized chondrosarcoma management for many decades, its efficacy in patients with metastatic chondrosarcoma remains unknown, and likewise we do not know whether there are any tumor- or patient-related factors associated with better survival after surgery for metastatic chondrosarcoma.

Questions/purposes (1) Is resection of the primary tumor associated with improved survival in patients with metastatic chondrosarcoma? (2) Which subgroups of patients with chondrosarcoma benefit more from resection in terms of survival?

Methods We identified 200 of 222 patients with metastatic chondrosarcoma in the Surveillance, Epidemiology, and End Results (SEER) database between 1988 and 2014 based on the exclusion criteria. Among those patients, 107 (53.5%) underwent primary tumor resection or amputation. Patient information, including demographics (patient age, gender, race, year of diagnosis), tumor characteristics (primary site, histologic subtype, tumor grade, tumor size), and treatment (record of operation and radiation), was collected and included in the study. Kaplan-Meier analyses, log-rank tests, competing risks framework, multivariable Cox regression modeling, and interaction tests were conducted to assess the association of primary tumor resection and survival in the overall cohort and subgroups.

Results Resection of the primary tumor was associated with improved overall survival (hazard ratio [HR], 0.481; 95% confidence interval [CI], 0.340–0.680; p < 0.001) and cancer-specific survival (HR, 0.493; 95% CI, 0.343–0.709; p < 0.001) after controlling for confounding variables. After controlling further for age, histologic subtype, and grade, primary tumor resection was associated with a survival advantage in patients with conventional subtype and Grade II chondrosarcoma (conventional subtype: HR, 0.403; 95% CI, 0.260–0.623 for overall survival and HR, 0.396; 95% CI, 0.250–0.627 for cancer-specific survival). However, primary tumor resection was not associated with increased survival in patients with metastatic chondrosarcoma who had the dedifferentiated subtype and Grade III malignancy.

Conclusions The present study demonstrates a possible favorable association between primary tumor resection and survival in some patients with metastatic chondrosarcoma at initial diagnosis. Specifically, patients with conventional subtypes and Grade II malignancies who underwent primary tumor resection had better survival compared with those patients who did not have primary tumor resection. Thus, there might be a benefit from primary tumor resection in these patients, but given the limitations of this database, further prospective studies or randomized trials are needed to confirm our findings. In the meantime, this information might be helpful to consider when discussing surgical options with patients who have conventional, Grade 2 metastatic chondrosarcoma at diagnosis.

Level of Evidence Level III, therapeutic study.

K. Song, J. Song, F. Chen, X. Ma, J. Jiang, Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai, China

K. Lin, Department of Orthopaedics, Zhongshan Hospital, Fudan University, Shanghai, China

The first two authors contributed equally to this manuscript.

J. Jiang, Department of Orthopaedics, Huashan Hospital, Fudan University, No. 12 Wulumuqizhong Road, Shanghai 200040, China, email: jianyuanjiang@126.com

Each author certifies that neither he or she, nor any member of his or her immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution waived approval for the reporting of this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Huashan Hospital, Shanghai, China.

Received May 17, 2018

Accepted December 13, 2018

© 2019 Lippincott Williams & Wilkins LWW
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