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Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours

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Abstract

Background

Little is known about the clinical outcome of children and adolescent patients with primary malignant sacral tumours.

Method

We retrospectively reviewed 40 patients with malignant sacral tumours aged ≤ 18 years, receiving surgery based on the previous proposed surgical resection classification at our centre from 2003 to 2018. The following data were collected in the present study: age, gender, radiological images, detailed information of the surgical procedure, pulmonary and other metastasis at presentation, complications, local recurrence, metastasis, and death during the follow-up were recorded from the clinical and follow-up files.

Results

The mean follow-up was 30.7 months (range, 5.2–146.7 months). The incidence of local recurrence was 27.5% (11/40). Seven cases had surgical site infection and there were 12 cases of wound dehiscence. One had a deep venous thrombosis and one had femoral artery thrombosis. Three had fixation breakage and then received a revision. Tenty-two patients (22/40, 55%) were free of disease. A total of 13 deaths (13/40, 32.5%) were observed and the mean overall survival period was 17.1 months (range, 6.3–34.2 months), and a pulmonary metastasis occurred in 18 patients (45%, 18/45) at the 12.0 ± 10.3 months (range, 2.2–35.3 months) after initial surgery. The overall survival rates at one, two and five years were respectively 88.3%, 62.5%, and 51.9%. In the stratification analysis of young patients with primary malignant tumours at the sacrum after surgery, it revealed the influence of pathological grade, location, and age on the oncological outcomes. Kaplan-Meier estimated a survivorship curve of patients with high and low-grade malignant tumours and showed statistical differences in the overall survival and distant relapse-free survival rates between two groups. Afterwards, the result demonstrated that paediatric patients aged ≤ 14 years had worse prognosis than those aged > 14 years.

Conclusions

It is satisfactory for the outcome of surgical treatment of children and adolescent patients with primary malignant sacral tumours based on proposed surgical classification. Furthermore, paediatric patients aged ≤ 14 years have the tendency of poor prognosis compared to adolescent aged > 14 years.

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Acknowledgments

Not applicable.

Funding

This work was supported by the Natural Science Foundation of China (NO:81702657) and Beijing Municipal Science & Technology Commission (No:Z181100001918025).

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Authors and Affiliations

  1. Musculoskeletal Tumor Center, Peking University People’s Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China

    Jun Wang, Dasen Li, Rongli Yang, Xiaodong Tang, Taiqiang Yan & Wei Guo

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  1. Jun Wang
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  2. Dasen Li
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  3. Rongli Yang
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  4. Xiaodong Tang
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  5. Taiqiang Yan
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  6. Wei Guo
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Correspondence to Wei Guo.

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Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Wang, J., Li, D., Yang, R. et al. Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours. International Orthopaedics (SICOT) 44, 1841–1851 (2020). https://doi.org/10.1007/s00264-020-04641-7

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  • DOI: https://doi.org/10.1007/s00264-020-04641-7

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