S. Z. Rheingold6, E. Kim6, L. Frankel6, M. Cardeiro6, D. Patel6, O. Rashid1,2,3,4,5,6 1Holy Cross Health, Michael And Dianne Biennes Comprehensive Cancer Center, Fort Lauderdale, FL, USA 2University of Miami, Leonard M. School Of Medicine, Miami, FL, USA 3Massachusetts General Hospital, Boston, MA, USA 4Broward Health, Fort Lauderdale, FL, USA 5Topline MD Alliance, Miami, FL, USA 6NOVA Southeastern University, Dr. Kiran C. Patel College Of Allopathic Medicine, Fort Lauderdale, FL, USA
Introduction: Multiple Sclerosis (MS) is the most common demyelinating disease, affecting approximately 400,000 people in the United States and 2.1 million people worldwide. Inflammatory damage and subsequent gliosis as well as the rise of immunosuppressive drugs have raised the question of whether there is an increased incidence of CNS cancer in those with MS. Studies have shown that previous to the advent of immunosuppressive drugs used in Multiple Sclerosis patients, there was no association between Multiple Sclerosis and Spinal Gliomas. This study aims to investigate the relationship between patients with MS and spinal gliomas (SG).
Methods: The Health Insurance Portability and Accountability Act (HIPAA) compliant national database was used to evaluate patients with and without multiple sclerosis. ICD-9 and ICD-10 codes were used. Holy Cross Health, Fort Lauderdale granted database access for the purpose of academic research. Patients were matched for age range and Charlson Comorbidity Index (CCI). Statistical significance was assessed using the Chi-squared test. 95,311 members from the database who matched the inclusion and exclusion criteria were then split into the experimental group (Patients with MS) and the control group (patients without MS) and were analyzed for the incidence of spinal gliomas.
Results: Statistical analysis showed an associated increased incidence of spinal gliomas in those with MS compared to those without MS (P-value < 2.2e-16, an OR of 2.69 (95%CI 2.16-3.36)). In the MS group, the average length of stay (LOS) (3.5 days) and amount paid per patient ($20.65) were lower than the control (LOS: 6.7 days, amount paid per patient: $79.73).
Conclusion: This study shows a statistically significant increase in the risk of spinal glioma formation in those with MS. No other studies in the literature were found that directly studied the association between spinal glioma and multiple sclerosis. The decreased LOS and amount paid per patient in the experimental group may be due to the already established medical record that these patients have or may be due to a decreased size and severity of the tumor from MS. The lack of data on the medications, such as immunosuppressives, that were taken by these patients is a limit to this study as immunosuppressive drugs have been shown to increase CNS tumor risk. Also, surveillance bias should be considered a confounding variable in this study as the increased SG detection could be due to the routine imaging done in MS patients. Further research needs to be done regarding the association between MS and SG to assess the results of this study.