Wednesday, September 26, 2018 2:00 PM – 3:00 PM Improving Quality of Life for Patients with Tumors: 80. High facility volume may improve survival in patients with primary bone tumors of the vertebral column.

BACKGROUND CONTEXT Primary bone tumors of the vertebral column (BTVC) are rare and represent a challenge when considering management options. It stands to reason that these complicated tumors would be best treated at high volume centers. However, this has not been well established. We investigated the largest registry of primary bone tumors, the National Cancer Database (NCDB); our goal was to determine the impact of facility case volume on outcomes in patients with primary BTVCs. PURPOSE Our goal was to determine the impact of facility case volume on outcomes in patients with primary BTVCs. STUDY DESIGN/SETTING Retrospective National Cancer Database review. PATIENT SAMPLE Patients with primary osteosarcoma, chondrosarcoma, chondroma and Ewing's sarcoma of the vertebral column identified in the National Cancer Database. OUTCOME MEASURES Long-term survival by Kaplan-Meier method and univariate or multivariate analyses of factors associated with survival. METHODS We retrospectively analyzed 941 patients in the NCDB from 2004 through 2015. Patients were stratified based on per year facility volume for primary BTVCs. Univariate and multivariate analyses were used to correlate specific outcome measures with these factors. Then, long-term survival between groups was evaluated using the Kaplan-Meier (KM) method with statistical comparisons based on the log-rank test. Multiple variables were analyzed between the two groups. RESULTS We identified 941 patients presenting with primary BTVCs; histological diagnosis was chondrosarcoma (n=243), chordoma (n=407), Ewing's sarcoma (n=164) and osteosarcoma (n=127). A total of 199 patients were treated at HVCs (>1 case annually) and 742 were treated at low-volume centers (LVC). Patients treated at high-volume centers were, on average, younger (48 vs. 52 years, p=.0076), more likely to be insured (p<.0001), and more likely to travel farther to the treating facility (mean 278 vs. 47 miles, p<.0001). There were no significant differences between high- and low-volume facilities regarding tumor characteristics. In a KM survival analysis, patients treated at high-volume facilities had better outcomes, with five-year survival rate of 67.7% vs. 58.7% (p=.0262). Patients treated at HVCs were also more likely to receive surgical treatment (87% vs. 79%, p=.0191), and, if surgery was performed, they were more likely to receive a radical resection (52.5% vs. 32.7%, p<.0001) and a trend toward fewer positive margins (29% vs. 38%, p=.084). CONCLUSIONS This is the largest patient cohort to date examining the impact of facility volume on outcomes in patients with primary BTVCs. Primary BTVCs are rare, even for HVCs; despite this, patient survival was significantly improved when treatment was performed at HVCs. Patients receiving treatment at HVC were more likely to receive a radical resection. There was a trend toward fewer margin positive resections. Further investigation is necessary to help improve the referral of appropriate patients to the HVCs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]