47. Impact of racial disparities on all-cause mortality in patients with a primary malignant or nonmalignant tumor of the spinal cord or spinal meninges: A propensity-score analysis

Abstract

<h3>BACKGROUND CONTEXT</h3> Racial disparities have been shown to impact various aspects of cancer care. Previous studies have demonstrated that nonwhite 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. <h3>PURPOSE</h3> The aim of this study was to investigate the influence of race on the outcomes of patients with primary malignant or nonmalignant tumor of the spinal cord or spinal meninges. <h3>STUDY DESIGN/SETTING</h3> Retrospective study. <h3>PATIENT SAMPLE</h3> Patients with primary malignant or nonmalignant tumor of the spinal cord or spinal meninges from 1973 through 2016. <h3>OUTCOME MEASURES</h3> All-cause mortality. <h3>METHODS</h3> 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 (C72.0) or spinal meninges (C70.1) from 1973 through 2016. Racial groups (African-American vs white) were balanced using propensity-score (PS) matching using a nonparsimonious 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. Associations of survival with clinical variables was assessed using doubly robust Cox proportional-hazards (CPH) regression analysis. <h3>RESULTS</h3> There were a total of 7,498 patients identified with a primary intradural spine tumor, of which 648 (6.8%) were African-American (White: 6,850 vs African-American: 648). The mean age of diagnosis was greater for patients who were White than it was for patients who were African-American (White: 55.1±17.4 years vs African-American: 50.0±16.0 years, p<0.0001). White patients were also less often female (White: 55.65% female vs African-American: 60.80% female, p=0.01). More than a third of tumors in White and African-American patients were malignant (White: 34.9% malignant vs African-American: 36.1% malignant, p=0.61) and most were benign (White: 53.8% benign vs African-American: 53.7% benign, p=0.61). Most patients in both race groups received a gross total or partial resection (White 58.2% resected vs African-American: 56.6% resected, p=0.47), while relatively few received chemotherapy (White: 5.9% chemotherapy vs African-American: 7.3% chemotherapy, p=0.19). 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, when controlling for other demographic, tumor, and treatment variables. <h3>CONCLUSIONS</h3> 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 impact all-cause mortality. Further studies are necessary to corroborate our findings. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.