Survival disparities in primary malignant spine tumors: a national analysis of academic and community hospital care.

Abstract

Objective: Primary malignant osseous tumors of the mobile spine are rare and require complex, multidisciplinary care. Treatment outcomes may differ between academic and community hospitals due to variations in resources, expertise, and infrastructure. This study evaluates demographics, care delivery patterns, and clinical outcomes, including both short- and long-term survival, for patients treated at academic versus community cancer programs using the National Cancer Database.

Methods: A retrospective analysis of a prospectively maintained database was performed. Nine hundred forty-three patients diagnosed with primary malignant osseous tumors of the mobile spine between 2004 and 2017 were identified. Patients were stratified by facility type: there were 601 patients treated at academic comprehensive cancer programs (ACADs) and 342 treated at comprehensive community cancer programs (CCCPs). Demographic, treatment, and clinical data were compared using descriptive statistics. Outcomes included inpatient length of stay, time to treatment, 30- and 90-day mortality, vital status at last contact, and overall survival. A multivariable Cox proportional hazards model assessed factors associated with overall survival.

Results: Patients at ACADs were significantly younger and more likely to have private insurance. The size and histopathological composition of the tumors did not differ significantly between facility types. ACAD patients experienced significantly longer inpatient stays and longer time to radiation initiation among patients receiving radiation with documented start dates. Time to chemotherapy did not significantly differ (p = 0.91). Thirty- and 90-day mortality were comparable between facility types among eligible surgical cases. At last follow-up, a significantly greater proportion of ACAD patients were alive (50.2% vs 38.3%, p < 0.001), and the median time from diagnosis to last contact or death was longer at ACADs (40.8 vs 33.2 months, p = 0.001). In the primary multivariable Cox model, treatment at an academic facility was associated with improved overall survival (hazard ratio [HR] 0.766, 95% CI 0.627-0.937; p = 0.009). In a sensitivity model adjusting for histopathology rather than grade, this association was attenuated and no longer statistically significant (CCCP vs ACAD, HR 1.19, p = 0.081).

Conclusions: Patients treated at academic centers had longer inpatient stays and longer time to radiation initiation, yet academic facility treatment was associated with improved overall survival in the primary multivariable model. After accounting for histopathological subtype in sensitivity analysis, the facility-type association was attenuated, suggesting survival differences reflect both tumor biology and system-level care pathways.