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Central Surgical Association

49th Annual Meeting

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Contemporary Outcomes of Surgical Resection for Chest Wall Chondrosarcoma
Jonathan D. Rice1, Christine E. Alvarado1, Philip A. Linden1, Anuja L. Sarode1, Sean J. Halloran2, Jillian Sinopoli1, Christopher W. Towe1
1Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States, 2University of Toledo Medical School, Toledo, Ohio, United States

Objective: Chest wall chondrosarcoma (CWC) is the most common primary chest wall malignant tumor and is historically associated with poor prognosis. Recommendations regarding surgical excision are based in small single institution studies and therefore at risk of bias. The purpose of this study was to use a large national database to assess the outcomes of surgery for CWC. We hypothesized that complete surgical excision remains the standard of care.

Methods: The 2018 National Cancer Databases for bone and soft tissue were merged to identify adult patients from 2004 to 2018 with chondrosarcoma. We compared clinical and demographic characteristics of patients with CWC relative to chondrosarcoma from other sites. The primary outcome was overall survival described using Kaplan Meier estimate. Univariable and multivariable Cox proportional hazard analysis was used to determine risk factors for poor survival among the CWC subgroup who underwent surgical resection.

Results: Among 11,925 patients with chondrosarcoma, 1,934 had a CWC. Relative to other sites, CWC was associated with older age (59 vs 55, p<0.001), male sex (1,193/1,934 (61.7%) vs 5,390/9,991 (53.9%), p<0.001), and white race (1,625/1,934 (84.0%) vs 7,894/9,991 (79.0%), p<0.001). CWCs were less likely to receive care at an academic/research program (782/1,618 (48.3%) vs 5,043/7,591 (63.4%), p<0.001). Among 1,791 CWC patients, the mean tumor size was 7.8 cm.

There were 10,377 patients with surgical treatment data. Patients with CWC were more likely to receive surgery (1,617/1,851 (87.4%) vs 7,065/8,526 (82.9%), p<0.001). The median hospitalization associated with surgery for CWC was 4 days (IQR 3-6) and readmission rate was 3.3% (52/1,541).

CWC was associated with 1-, 3-, 5-, and 10-year survival of 91.5%, 82.0%, 75.5%, and 62.7% respectively. Univariate Cox analysis showed that overall survival was strongly associated with surgical excision (HR 0.02, p<0.001) and (among patients receiving surgery) adversely affected by positive margins (HR 2.66, p<0.001). These relationships were confirmed in the multivariable analysis (Table).

Given the poor prognosis associated with a positive surgical margin, we performed a multivariable regression analysis to determine factors associated with positive surgical margin among CWC patients. This analysis showed that larger tumor size was independently associated with risk for positive margin (OR 1.04, p=0.008).

Conclusions: CWC represents a different cohort of patients relative to chondrosarcoma from other sites. Surgical resection remains the best treatment for these tumors, and positive surgical margin is associated with poor prognosis. Larger tumor size was associated with higher risk of positive margin.


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