Clinical Orthopaedics and Related Research®

, Volume 472, Issue 8, pp 2516–2525

Estimated Cause-specific Survival Continues to Improve Over Time in Patients With Chondrosarcoma

  • Kyle R. Duchman
  • Charles F. Lynch
  • Joseph A. Buckwalter
  • Benjamin J. Miller
Clinical Research

Abstract

Background

Conditional survival measures change in the risk of mortality given that a patient has survived a defined period of time. This has yet to be reported for chondrosarcoma of bone. This information should be of interest to the clinician and helpful in counseling patients with chondrosarcoma.

Questions/purposes

Our questions include the following: (1) Does the conditional survival of patients with local/regional chondrosarcoma improve with each additional year of survival? (2) Does the conditional survival of patients with metastatic chondrosarcoma improve with each additional year of survival? (3) Does tumor location, use of radiation, or patient age affect conditional survival? (4) Can chondrosarcoma ever be considered cured?

Methods

We used the Surveillance, Epidemiology, and End Results Program database maintained by the National Cancer Institute to identify 2138 patients with chondrosarcoma of bone from 1973 to 2009. We used an actuarial life table analysis to explore differences in 5-year cause-specific survival estimates conditional on 1 to 5 years of survival. The cohort was stratified by grade, location (axial versus extremity), use of radiation, and age. Finally, we expanded the analysis to include survival estimates 20 years after diagnosis conditional on survival for 5 and 10 years.

Results

The estimated survival for all grades of local/regional chondrosarcoma improved from baseline with each year of survival after diagnosis. At 5 years after diagnosis, local/regional Grade 1 chondrosarcoma displayed higher conditional survival than Grade 2 and 3 local/regional chondrosarcoma (97.2% [95% confidence interval {CI}, 95.2%–98.4%] versus 92.8% [95% CI, 89.5%–95.0%], p = 0.006 and 83.8% [95% CI, 69.9%–91.7%], p = 0.012). Estimated survival improved from baseline with each year of survival for all grades of metastatic chondrosarcoma. Conditional survival estimates for Grade 3 axial tumors failed to improve from baseline to 5 years after diagnosis (52.9% versus 70.2%, p > 0.05) compared with Grade 3 extremity tumors at baseline and 5 years after diagnosis (58.1% versus 95.8%, p < 0.0001) The 20-year conditional survival estimates reveal that a cancer-specific risk of mortality exists even 10 years after diagnosis, suggesting that although the conditional survival increases considerably over time, it cannot be considered cured.

Conclusions

The 5-year conditional survival estimate for patients with chondrosarcoma improved with each additional year of survival regardless of grade, site, age, or use of radiation. At 10 years after diagnosis, deaths attributable to cancer were still present, and patients should be aware of this small long-term risk.

Level of Evidence

Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

References

  1. 1.
    Aarons C, Potter BK, Adams SC, Pitcher JD Jr, Temple HT. Extended intralesional treatment versus resection of low-grade chondrosarcomas. Clin Orthop Relat Res. 2009;467:2105–2111.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Ambs A, Warren JL, Bellizzi KM, Topor M, Haffer SC, Clauser SB. Overview of the SEER–Medicare Health Outcomes Survey linked dataset. Health Care Financ Rev. 2008;29:5–21.PubMedGoogle Scholar
  3. 3.
    Angelini A, Guerra G, Mavrogenis AF, Pala E, Picci P, Ruggieri P. Clinical outcome of central conventional chondrosarcoma. J Surg Oncol. 2012;106:929–937.PubMedCrossRefGoogle Scholar
  4. 4.
    Bach PB, Guadagnoli E, Schrag D, Schussler N, Warren JL. Patient demographic and socioeconomic characteristics in the SEER-Medicare database—applications and limitations. Med Care. 2002;40:19–25.CrossRefGoogle Scholar
  5. 5.
    Bjornsson J, McLeod RA, Unni KK, Ilstrup DM, Pritchard DJ. Primary chondrosarcoma of long bones and limb girdles. Cancer. 1998;83:2105–2119.PubMedCrossRefGoogle Scholar
  6. 6.
    Bleyer A, Choi M, Fuller CD, Thomas CR Jr, Wang SJ. Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol. 2009;36:460–467.PubMedCrossRefGoogle Scholar
  7. 7.
    Choi M, Fuller CD, Thomas CR Jr, Wang SJ. Conditional survival in ovarian cancer: results from the SEER dataset 1988–2001. Gynecol Oncol. 2008;109:203–209.PubMedCrossRefGoogle Scholar
  8. 8.
    Damron TA, Ward WG, Stewart A. Osteosarcoma, chondrosarcoma, and Ewing’s sarcoma: National Cancer Data Base Report. Clin Orthop Relat Res. 2007;459:40–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Davis FG, McCarthy BJ, Freels S, Kupelian V, Bondy ML. The conditional probability of survival of patients with primary malignant brain tumors—Surveillance, Epidemiology and End Results (SEER) data. Cancer. 1999;85:485–491.PubMedCrossRefGoogle Scholar
  10. 10.
    Donati D, Colangeli S, Colangeli M, Di Bella C, Bertoni F. Surgical treatment of grade I central chondrosarcoma. Clin Orthop Relat Res. 2010;468:581–589.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Fiorenza F, Abudu A, Grimer RJ, Carter SR, Tillman RM, Ayoub K, Mangham DC. Risk factors for survival and local control in chondrosarcoma of bone. J Bone Joint Surg Br. 2002;84:93–99.PubMedCrossRefGoogle Scholar
  12. 12.
    Fritz A, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, Whelan S, eds. International Classification of Diseases for Oncology, 3rd Revision. Geneva, Switzerland: World Health Organization; 2000.Google Scholar
  13. 13.
    Fuller CD, Wang SJ, Thomas CR Jr, Hoffman HT, Weber RS, Rosenthal DI. Conditional survival in head and neck squamous cell carcinoma: results from the SEER dataset 1973–1998. Cancer. 2007;109:1331–1343.PubMedCrossRefGoogle Scholar
  14. 14.
    Gelderblom H, Hogendoorn PC, Dijkstra SD, van Rijswijk CS, Krol AD, Taminiau AH, Bovee JV. The clinical approach towards chondrosarcoma. Oncologist. 2008;13:320–329.PubMedCrossRefGoogle Scholar
  15. 15.
    Gitelis S, Bertoni F, Picci P, Campanacci M. Chondrosarcoma of bone. The experience at the Istituto Ortopedico Rizzoli. J Bone Joint Surg Am. 1981;63:1248–1257.PubMedGoogle Scholar
  16. 16.
    Giuffrida AY, Burgueno JE, Koniaris LG, Gutierrez JC, Duncan R, Scully SP. Chondrosarcoma in the United States (1973 to 2003): an analysis of 2890 cases from the SEER database. J Bone Joint Surg Am. 2009;91:1063–1072.PubMedCrossRefGoogle Scholar
  17. 17.
    Johnson DR, Ma DJ, Buckner JC, Hammack JE. Conditional probability of long-term survival in glioblastoma: a population-based analysis. Cancer. 2012;118:5608–5613.PubMedCrossRefGoogle Scholar
  18. 18.
    Krochak R, Harwood AR, Cummings BJ, Quirt IC. Results of radical radiation for chondrosarcoma of bone. Radiother Oncol. 1983;1:109–115.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee FY, Mankin HJ, Fondren G, Gebhardt MC, Springfield DS, Rosenberg AE, Jennings LC. Chondrosarcoma of bone: an assessment of outcome. J Bone Joint Surg Am. 1999;81:326–338.PubMedCrossRefGoogle Scholar
  20. 20.
    Leerapun T, Hugate RR, Inwards CY, Scully SP, Sim FH. Surgical management of conventional grade I chondrosarcoma of long bones. Clin Orthop Relat Res. 2007;463:166–172.PubMedGoogle Scholar
  21. 21.
    Lin PP, Alfawareh MD, Takeuchi A, Moon BS, Lewis VO. Sixty percent 10-year survival of patients with chondrosarcoma after local recurrence. Clin Orthop Relat Res. 2012;470:670–676.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Marcove RC, Mike V, Hutter RV, Huvos AG, Shoji H, Miller TR, Kosloff R. Chondrosarcoma of the pelvis and upper end of the femur. An analysis of factors influencing survival time in one hundred and thirteen cases. J Bone Joint Surg Am. 1972;54:561–572.PubMedGoogle Scholar
  23. 23.
    McNaney D, Lindberg RD, Ayala AG, Barkley HT, Hussey DH. Fifteen year radiotherapy experience with chondrosarcoma of bone. Int J Radiat Oncol Biol Phys. 1982;8:187–190.PubMedCrossRefGoogle Scholar
  24. 24.
    Merrill RM, Henson DE, Barnes M. Conditional survival among patients with carcinoma of the lung. Chest. 1999;116:697–703.PubMedCrossRefGoogle Scholar
  25. 25.
    Merrill RM, Hunter BD. Conditional survival among cancer patients in the United States. Oncologist. 2010;15:873–882.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Miller BJ, Lynch CF, Buckwalter JA. Conditional survival is greater than overall survival at diagnosis in patients with osteosarcoma and Ewing’s sarcoma. Clin Orthop Relat Res. 2013;471:3398–3404.PubMedCrossRefGoogle Scholar
  27. 27.
    Mohler DG, Chiu R, McCall DA, Avedian RS. Curettage and cryosurgery for low-grade cartilage tumors is associated with low recurrence and high function. Clin Orthop Relat Res. 2010;468:2765–2773.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    National Cancer Institute. National Cancer Institute Fact Sheet. Available at: http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities. Accessed June 3, 2013.
  29. 29.
    National Comprehensive Cancer Network. Available at: www.nccn.org/index.asp. Accessed December 28, 2012.
  30. 30.
    Nattinger AB, McAuliffe TL, Schapira MM. Generalizability of the Surveillance, Epidemiology, and End Results Registry population: factors relevant to epidemiologic and health care research. J Clin Epidemiol. 1997;50:939–945.PubMedCrossRefGoogle Scholar
  31. 31.
    Parsons HM, Habermann EB, Tuttle TM, Al-Refaie WB. Conditional survival of extremity soft-tissue sarcoma: results beyond the staging system. Cancer. 2011;117:1055–1060.PubMedCrossRefGoogle Scholar
  32. 32.
    Pring ME, Weber KL, Unni KK, Sim FH. Chondrosarcoma of the pelvis. A review of sixty-four cases. J Bone Joint Surg Am. 2001;83:1630–1642.PubMedGoogle Scholar
  33. 33.
    Rizzo M, Ghert MA, Harrelson JM, Scully SP. Chondrosarcoma of bone: analysis of 108 cases and evaluation for predictors of outcome. Clin Orthop Relat Res. 2001;391:224–233.PubMedCrossRefGoogle Scholar
  34. 34.
    Rueth NM, Groth SS, Tuttle TM, Virnig BA, Al-Refaie WB, Habermann EB. Conditional survival after surgical treatment of melanoma: an analysis of the Surveillance, Epidemiology, and End Results database. Ann Surg Oncol. 2010;17:1662–1668.PubMedCrossRefGoogle Scholar
  35. 35.
    Skeletal Lesions Interobserver Correlation among Expert Diagnosticians Study Group. Reliability of histopathologic and radiologic grading of cartilaginous neoplasms in long bones. J Bone Joint Surg Am. 2007;89:2113–2123.CrossRefGoogle Scholar
  36. 36.
    Soderstrom M, Ekfors TO, Bohling TO, Teppo LH, Vuorio EI, Aro HT. No improvement in the overal survival of 194 patients with chondrosarcoma in Finland in 1971–1990. Acta Orthop Scand. 2003;74:344–350.PubMedCrossRefGoogle Scholar
  37. 37.
    Staals EL, Bacchini P, Bertoni F. Dedifferentiated central chondrosarcoma. Cancer. 2006;106:2682–2691.PubMedCrossRefGoogle Scholar
  38. 38.
    Wang SJ, Emery R, Fuller CD, Kim JS, Sittig DF, Thomas CR. Conditional survival in gastric cancer: a SEER database analysis. Gastric Cancer. 2007;10:153–158.PubMedCrossRefGoogle Scholar
  39. 39.
    Wang SJ, Fuller CD, Emery R, Thomas CR. Conditional survival in rectal cancer: a SEER database analysis. Gastrointest Cancer Res. 2007;1:84–89.PubMedCentralPubMedGoogle Scholar
  40. 40.
    Wyman JJ, Hornstein AM, Meitner PA, Mak S, Verdier P, Block JA, Pan J, Terek RM. Multidrug resistance-1 and P-glycoprotein in human chondrosarcoma cell lines: expression correlates with decreased intracellular doxorubicin and in vitro chemoresistance. J Orthop Res. 1999;17:935–940.PubMedCrossRefGoogle Scholar
  41. 41.
    Xing Y, Chang GJ, Hu CY, Askew RL, Ross MI, Gershenwald JE, Lee JE, Mansfield PF, Lucci A, Cormier JN. Conditional survival estimates improve over time for patients with advanced melanoma: results from a population-based analysis. Cancer. 2010;116:2234–2241.PubMedCentralPubMedGoogle Scholar
  42. 42.
    Yu XQ, Baade PD, O’Connell DL. Conditional survival of cancer patients: an Australian perspective. BMC Cancer. 2012;12:460.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2014

Authors and Affiliations

  • Kyle R. Duchman
    • 1
  • Charles F. Lynch
    • 2
  • Joseph A. Buckwalter
    • 1
  • Benjamin J. Miller
    • 1
  1. 1.Department of Orthopaedics and RehabilitationUniversity of IowaIowa CityUSA
  2. 2.Department of EpidemiologyUniversity of Iowa College of Public HealthIowa CityUSA

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