Race and All-cause Mortality in Patients with a Primary Malignant or Nonmalignant Tumor of the Spinal Cord or Spinal Meninges: A Propensity-score Analysis. (16th November 2020)

• Record Type: Journal Article
• Authors: Elsamadicy, Aladine A; Freedman, Isaac G; Koo, Andrew B; David, Wyatt; Reeves, Benjamin; Antonios, Joseph P; Laurans, Maxwell; Kolb, Luis; Sciubba, Daniel M
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_203
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Previous studies have demonstrated that non-white race is associated with inferior outcomes for patients with neurological, spinal, and other tumors. However, the influence that race has on mortality rates in patients with spinal cord tumors is relatively unknown. METHODS: The Surveillance, Epidemiology, and End Results (SEER) Registry was used to identify all patients with a code for primary malignant or nonmalignant tumor of the spinal cord or spinal meninges from 1973 through 2016. Racial groups (African-American/Black vs. White) were balanced using propensity-score (PS) matching using a non-parsimonious 1:1 nearest neighbor matching algorithm. Overall survival (OS) estimates were obtained using the Kaplan-Meier method and compared across non-PS-matched and PS-matched groups using log-rank tests. RESULTS: There were a total of 7, 498 patients identified with 648 (6.8%) being African American and 6, 850 (93.2%) being White. African-American patients received radiation (RT) therapy more often than did white patients (White: 17.3% RT vs. African-American: 20.5% RT, p = 0.047). After PS-matching, both groups were balanced across all demographic, tumor, and treatment variables. African-American patients with primary intradural spine tumors were more likely to die of all causes than were white patients in both the non-PS-matched [HR: 1.26, 95% CI: (1.04, 1.51), p = 0.01] and PS-matched cohorts [HR: 1.64, 95% CI: (1.28, 2.11), p < 0.0001]. Patients who received RT were also more likely to die of all causes than were patients who did not in both the non-PS-matched [HR: 2.78, 95% CI: (2.43, 3.18), p < 0.0001] and PS-matched cohorts [HR: 3.15, 95% CI: (2.36, 4.19], p < 0.0001). On multivariate CPH regression analysis age at diagnosis [HR: 1.03, 95% CI: (1.02, 1.05), p < 0.0001], race [HR: 1.82, 95% CI: (1.22, 2.74), p = 0.004), and receipt of RT [HR: 2.62, 95% CI: (1.56, 4.37), p = 0.0002) were all significantly associated with all-cause mortality. CONCLUSION: Our study provides population-based estimates of the prognosis for patients with primary malignant or nonmalignant tumor of the spinal cord or spinal meninges and suggests that race may indepenently influence all-cause mortality.