1496. Association of Race and Socioeconomic Factors with Outcomes and Survival in WHO Grade II and III Spinal Meningioma; An Analysis of the National Cancer Database
Authors: James Wright, MD; Christina Wright; Gino Cioffi, MPH; Jill Barnholtz-Sloan, PhD; Andrew Sloan, MD; Manish Kasliwal, MD; Alia Hdeib, MD (Cleveland, OH)
WHO Grade II and III spinal meningiomas are rare but malignant tumors that can arise anywhere along the spinal axis. There are currently no large series that have examined survival or demographic and socioeconomic factors associated with survival in this group of patients. The objective of this study was to explore demographic, racial, treatment patterns, and socioeconomic factors that may be associated with treatment-related complications and survival in patients with WHO Grade II and III spinal meningioma by querying the National Cancer Database (NCDB).
NCDB queried for patients diagnosed with WHO Grade II and III spinal meningioma between 2004 and 2015. Descriptive statistics were calculated and stratified by race. Socioeconomic variables examined included insurance status, education, and income. Other variables examined were facility type, 30-day unplanned readmission, and 90-day mortality. Univariate Cox proportional hazards regression models were conducted to evaluate for associations with survival.
294 patients diagnosed with WHO Grade II/III spinal meningioma were identified (White n=243, Black n=33, Asian&Pacific Islander n=11, unknown n=7). Mean age at diagnosis was 56.7yrs. There was an overall female predominance (70%, n=206), however higher proportions of males were seen in Atypical and Papillary pathologies. Tumor types were Atypical (n=8), Clear Cell (n=148), Malignant (n=73), and Papillary (n=65). Treatment at Community Cancer Centers was associated with worse survival when compared to treatment in academic programs (HR 4.52 CI 1.19-17.11, p=.03). Patients with Medicaid had worse survival compared to those with private insurance (HR 13.8 CI 3.35-56.87) p=0.0003). The rate of unplanned 30-day readmission was 4.1%. Two patients died within 90 days of surgery.
This is the largest report of demographics and socioeconomic factors associated with survival in patients with WHO Grade II/III spinal meningiomas. Survival was improved when treatment was performed in Academic/Research Programs and when patients were privately insured.