# Exploring Pediatric Vertebral, Sacral, and Pelvic Osteosarcomas through the NCDB: Demographics, Treatment Utilization, and Survival Outcomes

## TL;DR

This study uses a cancer database to analyze the demographics, treatments, and survival rates of children with rare bone cancers in the spine, pelvis, and sacrum.

## Contribution

The study provides new insights into treatment patterns and survival outcomes for rare pediatric bone cancers using a large national database.

## Key findings

- Female patients with vertebral osteosarcomas had higher rates of regional lymph node involvement linked to increased mortality.
- Residual tumor and lack of radiotherapy were associated with worse outcomes in sacral and pelvic osteosarcomas.
- Hispanic ethnicity was linked to lower resection rates, possibly due to language barriers affecting care decisions.

## Abstract

Background and Objectives: Retrieve data from the National Cancer Database (NCDB) to examine information on the epidemiological prevalence, treatment strategies, and survival outcomes of pediatric vertebral, sacral and pelvic osteosarcomas. Methods: We reviewed NCDB data from 2008 to 2018, concentrating on vertebral, sacral, and pelvic osteosarcomas in children 0 to 21 years. Our analysis involved logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. Results: The study population included 207 patients. For vertebral osteosarcomas, 62.5% of patients were female, and 78.1% were white. Regional lymph node involvement predicted 80 times higher mortality hazard (p = 0.021). Distant metastasis predicted 25 times higher mortality hazard (p = 0.027). For sacral and pelvic osteosarcomas, 58.3% of patients were male, and 72% were white. Patients with residual tumor were 4 times more likely to have prolonged LOS (p = 0.031). No residual tumor (HR = 0.53, p = 0.03) and radiotherapy receipt (HR = 0.46, p = 0.034) were associated with lower mortality hazards. Distant metastasis predicted 3 times higher mortality hazard (p < 0.001). Hispanic ethnicity was linked to lower resection odds (OR = 0.342, p = 0.043), possibly due to language barriers affecting patient understanding and care decisions. Conclusions: In conclusion, our examination of NCDB offers a thorough exploration of demographics, treatment patterns, and results, highlighting the importance of personalized approaches to enhance patient outcomes.