Malignant Peripheral Nerve Sheath Tumor Of The Upper Extremity In The United States
Daniel Boczar, MD1, Maria T. Huayllani, MD1, Gabriela Cinotto, MD1, Aaron Spaulding, PhD1, Sanjay Bagaria, MD1, Oscar J. Manrique, MD2, Antonio J. Forte, MD. PhD1.
1Mayo Clinic, Jacksonville, FL, USA, 2Mayo Clinic, Rochester, MN, USA.
PORPOSE: The Malignant Peripheral Nerve Sheath Tumor is a rare soft tissue sarcoma of neural origin that has propensity for rapid progression and high mortality. This study aimed to investigate the National Cancer Database (NCDB) for patients presenting with malignant peripheral nerve sheath tumor of the upper extremity (MPNST), analyzing patient demographics, treatment, and tumor characteristics.
METHODS: Data was extracted from the NCDB for all patients diagnosed with peripheral nerve tumors of the upper extremity between 2004 and 2015, and divided based on histological subtypes (MPNST Vs. Other Histological Subtypes, OHS). Patient demographics, treatment, and tumor characteristics were described and analyzed using Chi-square or Mann-Whitney tests as appropriate. Multivariate analysis was performed using logistic regression to assess independent associations adjusting for confounders.
RESULTS: A total of 402 patients were included, 298 patients with MPNST (74.1%) and 104 with OHS (25.9%). Most of the patients with MPNST were age below 49 years (56.0%), men (52.3%), white (73.8%), and had private insurance (58.7%). Compared to OHS, MPNST was significantly more prevalent among patients with low income [living in zip codes with income <$38,000 (MPNST, 20.5% Vs. OHS, 8.7%; P=0.02)] and low education [% of adults without high school diploma > 21% (MPNST, 21.8% Vs. OHS, 11.5%; P=0.04)]. Moreover, patients with MPNST had a longer time between diagnosis and most effective surgery [MPNST, 43.87 days (SD 57.31) Vs. OHS, 29.7 days (SD 50.63); P=0.013]. Multivariate analysis adjusted for confounders demonstrated higher odds of MPNST in men [OR 1.99 (1.20–3.31); P=0.008].
CONCLUSIONS: This national database analysis of predictive factors associated with Malignant Peripheral Nerve Sheet Tumors and may have the potential to influence diagnostic guidelines and treatment protocols for such lesions.
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