Abstract
e23506
Background: There are significant differences in prognosis for osteosarcoma, Ewing Sarcoma, chondrosarcoma, & chordomas based on stage at diagnosis. 5-year survival at early stage vs late stage is as follows; osteosarcoma 75% vs 27%, Ewing sarcoma 82% vs 39%, chondrosarcoma 78% vs 22%, and chordomas 87% vs 55%. This study seeks to evaluate the socioeconomic and geographical factors that affect the odds of late-stage bone cancer diagnosis. Methods: This study retrospectively evaluated the risk of stage I vs stage IV cancer at diagnosis in patients with primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma & chordoma) diagnosed and recorded in the National Cancer Database (NCDB) between 2004 and 2018. Patients were identified by ICD-O-3 codes and patients with other malignancies were excluded. Cross Tabulations with Chi-square analysis was performed to evaluate frequencies of different socioeconomic and geographical characteristics between groups. Multivariable binary logistic regression was performed to evaluate relationships between socioeconomic and geographical factors and the odds of stage IV cancer. Statistical significance was set at α = 0.05. Results: 11,945 patients with stage I or stage IV primary malignant bone tumors were identified. Odds of stage IV bone cancer at diagnosis increased in patients of greater age (odds ratio [OR] = 1.011, 95% confidence interval [CI]: 1.003-1.018). Odds of stage IV bone cancer at diagnosis were decreased with female sex (OR = 0.747, 95% CI: 0.647-0.862), private insurance (OR = 0.519, 95% CI: 0.367-0.732), Medicare insurance (OR = 0.664, 95% CI: 0.456-0.965), or with diagnosis at comprehensive cancer center programs (OR = 0.549, 95% CI: 0.371-0.814), academic/research programs (OR = 0.339, 95% CI: 0.232-0.495), or integrated cancer network programs (OR = 0.392, 95% CI: 0.261-0.587). No significant relationship was identified between stage at diagnosis and race, ethnicity, Charlson-Deyo score, income, education, region, travel distance, or urban/rural status. Conclusions: Odds of stage IV bone cancer at diagnosis are greater with increasing age, male sex, non-private or non-Medicare insurance status, or treatment at community cancer programs.