Pediatric versus adult cases of primary osseous sarcomas of the spine: A population-based analysis

Abstract

Background

Primary osseous sarcomas of the spine provide a challenge due to their anatomic location and aggressiveness. While chemotherapy, radiation, and surgery are frequently employed as treatments for these neoplasms, their efficacy has not been compared between children and adults.

Methods

Using the Surveillance, Epidemiology, and End Results database (2000–2021), 455 patients were identified with confirmed osteosarcoma, Ewing’s sarcoma, or chondrosarcoma. Demographic, tumor, and treatment characteristics were analyzed. Cox proportional hazard models were used to evaluate mortality predictors, and Kaplan–Meier survival analysis was performed.

Results

For the entire cohort, increasing age (hazard ratio [HR]=1.03; 95% confidence interval [CI]=1.01–1.04; p<.001), an osteosarcoma diagnosis (HR=2.06; CI=1.17–3.61; p=.0019), and increasing tumor size (HR=1.01, CI=1–1.02, p=.007) increased mortality risk. For adults, age, an osteosarcoma diagnosis, male sex (HR=1.94; CI=1.07–3.52; p=.0297) and Black race (HR=3.16; CI=1.07–9.34; p=.0374) conferred a poor prognosis. Subtotal tumor resection was protective for adults (HR=0.29; CI=0.09–0.92; p=.0355). For children, only increasing age (HR=1.13; CI=1.03–1.23; p=.00678) decreased survival. Kaplan–Meier analysis revealed cohort-wide median cancer-specific survival (CSS) of 82 months, with 5- and 10-year survival rates of 53% and 47%. Adult median CSS was 34 months, with 5- and 10-year survival rates of 44% and 37%. Median CSS was not reached in the pediatric cohort, with 5- and 10-year CSS rates of 69% and 64%.

Conclusions

Children experienced improved CSS compared to adults. While resections were associated with survival in adults, survival in pediatric patients was not significantly influenced by treatment-related variables. These findings suggest that patient age and histology should guide prognosis and treatment strategy.