Conditional Survival Is Greater Than Overall Survival at Diagnosis in Patients With Osteosarcoma and Ewing’s Sarcoma
Conditional survival is a measure of the risk of mortality given that a patient has survived a defined period of time. These estimates are clinically helpful, but have not been reported previously for osteosarcoma or Ewing’s sarcoma.
We determined the conditional survival of patients with osteosarcoma and Ewing’s sarcoma given survival of 1 or more years.
We used the Surveillance, Epidemiology, and End Results (SEER) Program database to investigate cases of osteosarcoma and Ewing’s sarcoma in patients younger than 40 years from 1973 to 2009. The SEER Program is managed by the National Cancer Institute and provides survival data gathered from population-based cancer registries. We used an actuarial life table analysis to determine any cancer cause-specific 5-year survival estimates conditional on 1 to 5 years of survival after diagnosis. We performed a similar analysis to determine 20-year survival from the time of diagnosis.
The estimated 5-year survival improved each year after diagnosis. For local/regional osteosarcoma, the 5-year survival improved from 74.8% at baseline to 91.4% at 5 years—meaning that if a patient with localized osteosarcoma lives for 5 years, the chance of living for another 5 years is 91.4%. Similarly, the 5-year survivals for local/regional Ewing’s sarcoma improved from 72.9% at baseline to 92.5% at 5 years, for metastatic osteosarcoma 35.5% at baseline to 85.4% at 5 years, and for metastatic Ewing’s sarcoma 31.7% at baseline to 83.6% at 5 years. The likelihood of 20-year cause-specific survival from the time of diagnosis in osteosarcoma and Ewing’s sarcoma was almost 90% or greater after 10 years of survival, suggesting that while most patients will remain disease-free indefinitely, some experience cancer-related complications years after presumed eradication.
The 5-year survival estimates of osteosarcoma and Ewing’s sarcoma improve with each additional year of patient survival. Knowledge of a changing risk profile is useful in counseling patients with time. The presence of cause-specific mortality decades after treatment supports lifelong monitoring in this population.
Level of Evidence
Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
- Armstrong GT, Liu Q, Yasui Y, Neglia JP, Leisenring W, Robison LL, Mertens AC. Late mortality among 5-year survivors of childhood cancer: a summary from the Childhood Cancer Survivor Study. J Clin Oncol. 2009;27:2328–2338. CrossRef
- Bacci G, Forni C, Longhi A, Ferrari S, Donati D, De Paolis M, Barbieri E, Pignotti E, Rosito P, Versari M. Long-term outcome for patients with non-metastatic Ewing’s sarcoma treated with adjuvant and neoadjuvant chemotherapies: 402 patients treated at Rizzoli between 1972 and 1992. Eur J Cancer. 2004;40:73–83. CrossRef
- Bielack SS, Kempf-Bielack B, Delling G, Exner GU, Flege S, Helmke K, Kotz R, Salzer-Kuntschik M, Werner M, Winkelmann W, Zoubek A, Jurgens H, Winkler K. Prognostic factors in high-grade osteosarcoma of the extremities or trunk: an analysis of 1,702 patients treated on neoadjuvant cooperative osteosarcoma study group protocols. J Clin Oncol. 2002;20:776–790. CrossRef
- Bleyer A, Choi M, Fuller CD, Thomas CR Jr, Wang SJ. Relative lack of conditional survival improvement in young adults with cancer. Semin Oncol. 2009;36:460–467. CrossRef
- Choi M, Fuller CD, Thomas CR Jr, Wang SJ. Conditional survival in ovarian cancer: results from the SEER dataset 1988–2001. Gynecol Oncol. 2008;109:203–209. CrossRef
- Davis FG, McCarthy BJ, Freels S, Kupelian V, Bondy ML. The conditional probability of survival of patients with primary malignant brain tumors: surveillance, epidemiology, and end results (SEER) data. Cancer. 1999;85:485–491. CrossRef
- Ek ET, Ojaimi J, Kitagawa Y, Choong PF. Outcome of patients with osteosarcoma over 40 years of age: is angiogenesis a marker of survival? Int Semin Surg Oncol. 2006;3:7. CrossRef
- Engels EA, Fraumeni JF Jr. New Malignancies Following Cancer of the Bone and Soft Tissue, and Kaposi Sarcoma. In: Curtis RE, Freedman DM, Ron E, Ries LAG, Hacker DG, Edwards BK, Tucker MA, Fraumeni JF Jr, eds. New Malignancies Among Cancer Survivors: SEER Cancer Registries, 1973–2000. NIH Publ. No. 05-5302. Bethesda, MD: National Cancer Institute; 2006:313–337.
- Esiashvili N, Goodman M, Marcus RB Jr. Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance Epidemiology and End Results data. J Pediatr Hematol Oncol. 2008;30:425–430. CrossRef
- Fritz A, Jack A, Shanmugaratnam K, Sobin L, Parkin DM, Whelan S, eds. International Classification of Diseases for Oncology. 3 rd ed. Geneva, Switzerland: World Health Organization; 2000.
- Fuller CD, Wang SJ, Thomas CR Jr, Hoffman HT, Weber RS, Rosenthal DI. Conditional survival in head and neck squamous cell carcinoma: results from the SEER dataset 1973–1998. Cancer. 2007;109:1331–1343. CrossRef
- Grimer RJ, Cannon SR, Taminiau AM, Bielack S, Kempf-Bielack B, Windhager R, Dominkus M, Saeter G, Bauer H, Meller I, Szendroi M, Folleras G, San-Julian M, van der Eijken J. Osteosarcoma over the age of forty. Eur J Cancer. 2003;39:157–163. CrossRef
- Handelsman H, Carter SK. Current therapies in osteosarcoma. Cancer Treat Rev. 1975;2:77–83. CrossRef
- Henson DE, Ries LA. On the estimation of survival. Semin Surg Oncol. 1994;10:2–6. CrossRef
- Henson DE, Ries LA, Carriaga MT. Conditional survival of 56,268 patients with breast cancer. Cancer. 1995;76:237–242. CrossRef
- Johnson DR, Ma DJ, Buckner JC, Hammack JE. Conditional probability of long-term survival in glioblastoma: a population-based analysis. Cancer. 2012;118:5608–5613. CrossRef
- Katz MH, Hu CY, Fleming JB, Pisters PW, Lee JE, Chang GJ. Clinical calculator of conditional survival estimates for resected and unresected survivors of pancreatic cancer. Arch Surg. 2012;147:513–519. CrossRef
- Mack JW, Wolfe J, Cook EF, Grier HE, Cleary PD, Weeks JC. Hope and prognostic disclosure. J Clin Oncol. 2007;25:5636–5642. CrossRef
- Mack JW, Wolfe J, Grier HE, Cleary PD, Weeks JC. Communication about prognosis between parents and physicians of children with cancer: parent preferences and the impact of prognostic information. J Clin Oncol. 2006;24:5265–5270. CrossRef
- Merrill RM, Henson DE, Barnes M. Conditional survival among patients with carcinoma of the lung. Chest. 1999;116:697–703. CrossRef
- Merrill RM, Hunter BD. Conditional survival among cancer patients in the United States. Oncologist. 2010;15:873–882. CrossRef
- Mirabello L, Troisi RJ, Savage SA. Osteosarcoma incidence and survival rates from 1973 to 2004: data from the Surveillance, Epidemiology, and End Results Program. Cancer. 2009;115:1531–1543. CrossRef
- National Cancer Institute. National Cancer Institute Fact Sheet.Available at: http://www.cancer.gov/cancertopics/factsheet/disparities/cancer-health-disparities. Accessed June 3, 2013.
- National Comprehensive Cancer Network. Available at: http:www.nccn.org/index.asp. Accessed December 28, 2012.
- Parsons HM, Habermann EB, Tuttle TM, Al-Refaie WB. Conditional survival of extremity soft-tissue sarcoma: results beyond the staging system. Cancer. 2011;117:1055–1060. CrossRef
- Reulen RC, Winter DL, Frobisher C, Lancashire ER, Stiller CA, Jenney ME, Skinner R, Stevens MC, Hawkins MM; British Childhood Cancer Survivor Study Steering Group. Long-term cause-specific mortality among survivors of childhood cancer. JAMA. 2010;304:172–179. CrossRef
- Rueth NM, Groth SS, Tuttle TM, Virnig BA, Al-Refaie WB, Habermann EB. Conditional survival after surgical treatment of melanoma: an analysis of the Surveillance, Epidemiology, and End Results database. Ann Surg Oncol. 2010;17:1662–1668. CrossRef
- Skinner R, Wallace WH, Levitt GA; UK Children’s Cancer Study Group Late Effects Group. Long-term follow-up of people who have survived cancer during childhood. Lancet Oncol. 2006;7:489–498. CrossRef
- Sun M, Abdollah F, Bianchi M, Trinh QD, Shariat SF, Jeldres C, Tian Z, Hansen J, Briganti A, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Conditional survival of patients with urothelial carcinoma of the urinary bladder treated with radical cystectomy. Eur J Cancer. 2012;48:1503–1511. CrossRef
- Wang SJ, Emery R, Fuller CD, Kim JS, Sittig DF, Thomas CR. Conditional survival in gastric cancer: a SEER database analysis. Gastric Cancer. 2007;10:153–158. CrossRef
- Wang SJ, Fuller CD, Emery R, Thomas CR. Conditional survival in rectal cancer: a SEER database analysis. Gastrointest Cancer Res. 2007;1:84–89.
- Xing Y, Chang GJ, Hu CY, Askew RL, Ross MI, Gershenwald JE, Lee JE, Mansfield PF, Lucci A, Cormier JN. Conditional survival estimates improve over time for patients with advanced melanoma: results from a population-based analysis. Cancer. 2010;116:2234–2241.
- Conditional Survival Is Greater Than Overall Survival at Diagnosis in Patients With Osteosarcoma and Ewing’s Sarcoma
Clinical Orthopaedics and Related Research®
Volume 471, Issue 11 , pp 3398-3404
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr., 01015 JPP, Iowa City, IA, 52246, USA
- 2. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA