Skip to main content

Advertisement

SpringerLink
Log in

Racial disparities in the management and outcomes of primary osseous neoplasms of the spine: a SEER analysis

  • Research
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Primary osseous neoplasms of the spine, including Ewing’s sarcoma, osteosarcoma, chondrosarcoma, and chordoma, are rare tumors with significant morbidity and mortality. The present study aims to identify the prevalence and impact of racial disparities on management and outcomes of patients with these malignancies.

Methods

The 2000 to 2020 Surveillance, Epidemiology, and End Results (SEER) Registry, a cancer registry, was retrospectively reviewed to identify patients with Ewing’s sarcoma, osteosarcoma, chondrosarcoma, or chordoma of the vertebral column or sacrum/pelvis. Study patients were divided into race-based cohorts: White, Black, Hispanic, and Other. Demographics, tumor characteristics, treatment variables, and mortality were assessed.

Results

2,415 patients were identified, of which 69.8% were White, 5.8% Black, 16.1% Hispanic, and 8.4% classified as “Other”. Tumor type varied significantly between cohorts, with osteosarcoma affecting a greater proportion of Black patients compared to the others (p < 0.001). A lower proportion of Black and Other race patients received surgery compared to White and Hispanic patients (p < 0.001). Utilization of chemotherapy was highest in the Hispanic cohort (p < 0.001), though use of radiotherapy was similar across cohorts (p = 0.123). Five-year survival (p < 0.001) and median survival were greatest in White patients (p < 0.001). Compared to non-Hispanic Whites, Hispanic (p < 0.001) and “Other” patients (p < 0.001) were associated with reduced survival.

Conclusion

Race may be associated with tumor characteristics at diagnosis (including subtype, size, and site), treatment utilization, and mortality, with non-White patients having lower survival compared to White patients. Further studies are necessary to identify underlying causes of these disparities and solutions for eliminating them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Walcott BP, Nahed BV, Mohyeldin A, Coumans JV, Kahle KT, Ferreira MJ (2012) Chordoma: current concepts, management, and future directions. Lancet Oncol 13(2):e69-76. https://doi.org/10.1016/s1470-2045(11)70337-0

    Article  PubMed  Google Scholar 

  2. Ferguson JL, Turner SP (2018) Bone cancer: diagnosis and treatment principles. Am Fam Physician 98(4):205–213

    PubMed  Google Scholar 

  3. Siegel RL, Miller KD, Wagle NS, Jemal A (2023) Cancer statistics, 2023. CA Cancer J Clin 73(1):17–48. https://doi.org/10.3322/caac.21763

    Article  PubMed  Google Scholar 

  4. Sundaresan N, Rosen G, Boriani S (2009) Primary malignant tumors of the spine. Orthop Clin North Am 40(1):21–36, v. https://doi.org/10.1016/j.ocl.2008.10.004

  5. Rustagi T, Schwab JH, Iwenofu H, Mendel E (2022) Overview of the management of primary tumors of the spine. Int J Neurosci 132(6):543–557. https://doi.org/10.1080/00207454.2020.1825423

    Article  PubMed  Google Scholar 

  6. De la Garza RR, Benton JA, Gelfand Y et al (2020) Racial disparities in clinical presentation, type of intervention, and in-hospital outcomes of patients with metastatic spine disease: An analysis of 145,809 admissions in the United States. Cancer Epidemiol 68:101792. https://doi.org/10.1016/j.canep.2020.101792

    Article  Google Scholar 

  7. Hung B, Pennington Z, Hersh AM et al (2022) Impact of race on nonroutine discharge, length of stay, and postoperative complications after surgery for spinal metastases. J Neurosurg Spine 36(4):678–685. https://doi.org/10.3171/2021.7.Spine21287

    Article  PubMed  Google Scholar 

  8. Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP (2009) Ewing sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973–2005. Cancer 115(15):3526–3536. https://doi.org/10.1002/cncr.24388

    Article  PubMed  Google Scholar 

  9. McMaster ML, Goldstein AM, Bromley CM, Ishibe N, Parry DM (2001) Chordoma: incidence and survival patterns in the United States, 1973–1995. Cancer Causes Control 12(1):1–11. https://doi.org/10.1023/a:1008947301735

    Article  CAS  PubMed  Google Scholar 

  10. Ullah A, Kenol GS, Lee KT et al (2023) Chordoma: demographics and survival analysis with a focus on racial disparities and the role of surgery, a U.S. population-based study. Clin Transl Oncol. https://doi.org/10.1007/s12094-023-03227-0

    Article  PubMed  Google Scholar 

  11. Pan Y, Lu L, Chen J, Zhong Y, Dai Z (2018) Analysis of prognostic factors for survival in patients with primary spinal chordoma using the SEER Registry from 1973 to 2014. J Orthop Surg Res 13(1):76. https://doi.org/10.1186/s13018-018-0784-3

    Article  PubMed  PubMed Central  Google Scholar 

  12. Arshi A, Sharim J, Park DY et al (2017) Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine. Spine J 17(5):645–655. https://doi.org/10.1016/j.spinee.2016.11.002

    Article  PubMed  Google Scholar 

  13. Penumarthy NL, Goldsby RE, Shiboski SC, Wustrack R, Murphy P, Winestone LE (2020) Insurance impacts survival for children, adolescents, and young adults with bone and soft tissue sarcomas. Cancer Med 9(3):951–958. https://doi.org/10.1002/cam4.2739

    Article  PubMed  Google Scholar 

  14. Hu X, Fujiwara T, Houdek MT et al (2022) Impact of racial disparities and insurance status in patients with bone sarcomas in the USA : a population-based cohort study. Bone Joint Res 11(5):278–291. https://doi.org/10.1302/2046-3758.115.Bjr-2021-0258.R2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Diessner BJ, Weigel BJ, Murugan P, Zhang L, Poynter JN, Spector LG (2020) Associations of socioeconomic status, public vs private insurance, and race/ethnicity with metastatic sarcoma at diagnosis. JAMA Netw Open. 3(8):e2011087. https://doi.org/10.1001/jamanetworkopen.2020.11087

    Article  PubMed  PubMed Central  Google Scholar 

  16. Dorfman HD, Czerniak B (1995) Bone cancers. Cancer 75(1 Suppl):203–210. https://doi.org/10.1002/1097-0142(19950101)75:1+%3c203::aid-cncr2820751308%3e3.0.co;2-v

    Article  CAS  PubMed  Google Scholar 

  17. Kerr DL, Dial BL, Lazarides AL et al (2019) Epidemiologic and survival trends in adult primary bone tumors of the spine. Spine J 19(12):1941–1949. https://doi.org/10.1016/j.spinee.2019.07.003

    Article  PubMed  Google Scholar 

  18. Mukherjee D, Chaichana KL, Parker SL, Gokaslan ZL, McGirt MJ (2013) Association of surgical resection and survival in patients with malignant primary osseous spinal neoplasms from the Surveillance, Epidemiology, and End Results (SEER) database. Eur Spine J 22(6):1375–1382. https://doi.org/10.1007/s00586-012-2621-4

    Article  PubMed  Google Scholar 

  19. Lapica H, Ozery M, Raju H, Castro G, Rodriguez de la Vega P, Barengo NC (2022) The associations between racial disparities, health insurance, and the use of amputation as treatment for malignant primary bone neoplasms in the US: a retrospective analysis from 1998 to 2016. Int J Environ Res Public Health 19(10). https://doi.org/10.3390/ijerph19106289

  20. Malik AT, Alexander JH, Mayerson JL, Khan SN, Scharschmidt TJ (2020) Is surgical resection of the primary site associated with an improved overall survival for patients with primary malignant bone tumors who have metastatic disease at presentation? Clin Orthop Relat Res 478(10):2284–2295. https://doi.org/10.1097/corr.0000000000001361

    Article  PubMed  PubMed Central  Google Scholar 

  21. Smartt AA, Jang ES, Tyler WK (2020) Is There an association between insurance status and survival and treatment of primary bone and extremity soft-tissue sarcomas? A SEER database study. Clin Orthop Relat Res 478(3):527–536. https://doi.org/10.1097/corr.0000000000000889

    Article  PubMed  Google Scholar 

  22. Deb S, Brewster R, Pendharkar AV, Veeravagu A, Ratliff J, Desai A (2019) Socioeconomic predictors of surgical resection and survival for patients with osseous spinal neoplasms. Clin Spine Surg 32(3):125–131. https://doi.org/10.1097/bsd.0000000000000738

    Article  PubMed  Google Scholar 

  23. Elsamadicy AA, Wang C, Reeves BC et al (2023) Socioeconomic and racial/ethnic disparities in perception of health status and literacy in spine oncological patients: insights from the all of us research program. Spine 48(15):1107–1115

    Article  PubMed  Google Scholar 

  24. Chen CH, Tang ST, Chen CH (2012) Meta-analysis of cultural differences in Western and Asian patient-perceived barriers to managing cancer pain. Palliat Med 26(3):206–221

    Article  PubMed  Google Scholar 

  25. Fuh KC, Shin JY, Kapp DS et al (2015) Survival differences of Asian and Caucasian epithelial ovarian cancer patients in the United States. Gynecol Oncol 136(3):491–497

    Article  PubMed  Google Scholar 

  26. Husson O, Mols F, Fransen M, Van De Poll-Franse L, Ezendam N (2015) Low subjective health literacy is associated with adverse health behaviors and worse health-related quality of life among colorectal cancer survivors: Results from the profiles registry. Psychooncology 24(4):478–486

    Article  CAS  PubMed  Google Scholar 

  27. Ellis L, Canchola AJ, Spiegel D, Ladabaum U, Haile R, Gomez SL (2018) Trends in cancer survival by health insurance status in California from 1997 to 2014. JAMA Oncol 4(3):317–323

    Article  PubMed  Google Scholar 

  28. Niu X, Roche LM, Pawlish KS, Henry KA (2013) Cancer survival disparities by health insurance status. Cancer Med 2(3):403–411

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jang BS, Chang JH (2019) Socioeconomic status and survival outcomes in elderly cancer patients: A national health insurance service-elderly sample cohort study. Cancer Med 8(7):3604–3613

    Article  PubMed  PubMed Central  Google Scholar 

  30. Zavala VA, Bracci PM, Carethers JM et al (2021) Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 124(2):315–332

    Article  PubMed  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Aladine A. Elsamadicy, Sumaiya Sayeed, Josiah J. Z. Sherman, Astrid C. Hengartner & Ehud Mendel

  2. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Zach Pennington

  3. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Andrew M. Hersh

  4. Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA

    Sheng-Fu Larry Lo & Daniel M. Sciubba

  5. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    John H. Shin

Authors
  1. Aladine A. Elsamadicy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sumaiya Sayeed
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Josiah J. Z. Sherman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Astrid C. Hengartner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zach Pennington
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrew M. Hersh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sheng-Fu Larry Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John H. Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ehud Mendel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Daniel M. Sciubba
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Aladine A. Elsamadicy M.D. – Conceptualization, Supervision, Writing – original draft, Writing – review & editing Sumaiya Sayeed B.S. – Data curation, Methodology, Software, Formal analysis, Writing – original draft, Writing – review & editing Josiah J.Z. Sherman B.S. – Writing – original draft Astrid C. Hengartner B.S. – Writing – original draft Zach Pennington M.D. – Writing – review & editing Andrew M. Hersh A.B. – Writing – review & editing Sheng-Fu Larry Lo M.D., M.H.S. – Writing – review & editing John H. Shin, M.D. – Writing – review & editing Ehud Mendel M.D., M.B.A. – Writing – review & editing, Supervision Daniel M. Sciubba M.D., M.B.A– Writing – review & editing, Supervision

Corresponding author

Correspondence to Aladine A. Elsamadicy.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elsamadicy, A.A., Sayeed, S., Sherman, J.J.Z. et al. Racial disparities in the management and outcomes of primary osseous neoplasms of the spine: a SEER analysis. J Neurooncol 166, 293–301 (2024). https://doi.org/10.1007/s11060-023-04557-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-023-04557-3

Keywords

Search

Navigation