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Does primary tumor resection improve survival for patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at diagnosis ?

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Abstract

Background

Recent studies demonstrated that primary tumor resection (PTR) improves survival of patients with metastatic bone sarcomas. However, it remains quite unclear regarding the role of PTR in the treatment of sarcomas of pelvic bones with synchronous metastasis at diagnosis.

Methods

Using the Surveillance, Epidemiology, and End Results Program, we enrolled a total of 385 patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at initial diagnosis, including 139 patients with osteosarcoma, 176 with Ewing sarcoma, and 70 with chondrosarcoma. Association between PTR and disease-specific survival (DSS) were investigated using the univariable and multivariable Cox regression models. Hazard ratio (HR) and 95% confidence interval (CI) were reported. Representative institutional PTR strategies and clinical outcomes for patients with metastatic pelvic sarcomas from our cancer center were displayed.

Results

The usage rate of PTR was 28.1% (39/139) in osteosarcoma, 13.6% (24/176) in Ewing sarcoma, and 41.4% (29/70) in chondrosarcoma with synchronous metastatic lesions. PTR was not associated with an improved DSS for metastatic pelvic osteosarcoma (HR = 0.686, 95% CI = 0.430 ~ 1.094, P = 0.113) and Ewing sarcoma (HR = 0.580, 95% CI = 0.291 ~ 1.154, P = 0.121). The use of PTR was associated with an improved DSS for metastatic pelvic chondrosarcoma (HR = 0.464, 95% CI = 0.225 ~ 0.954, P = 0.037).

Conclusion

Primary lesion resection may provide a survival benefit for metastatic chondrosarcoma, but not for osteosarcoma and Ewing sarcoma of pelvic bones, sacrum, and coccyx. This population-based study recommends an active surgical intervention for metastatic chondrosarcoma while non-surgical treatment for metastatic osteosarcoma and Ewing sarcoma of the pelvis in terms of survival improvement.

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Data availability

All data were extracted from the Surveillance, Epidemiology, and End Results Program (https://seer.cancer.gov/).

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Funding

This study is supported by the Shanghai Municipal Health Commission Research Project (20194Y0242).

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Authors and Affiliations

  1. Department of Musculoskeletal Oncology, Spinal Tumor Center, Fudan University Shanghai Cancer Center, Shanghai, China

    Xianglin Hu, Yangbai Sun, Wending Huang & Wangjun Yan

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Xianglin Hu, Yangbai Sun, Wending Huang & Wangjun Yan

  3. Department of Orthopaedic Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan

    Tomohiro Fujiwara

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  1. Xianglin Hu
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Corresponding authors

Correspondence to Yangbai Sun, Wending Huang or Wangjun Yan.

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Ethical approval was waived for this study because of the de-identified information of the patients in the public Surveillance, Epidemiology, and End Results Program.

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Hu, X., Fujiwara, T., Sun, Y. et al. Does primary tumor resection improve survival for patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at diagnosis ?. Eur Spine J 32, 4362–4376 (2023). https://doi.org/10.1007/s00586-023-07985-x

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  • DOI: https://doi.org/10.1007/s00586-023-07985-x

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