Low Survival Rates for Pediatric Patients with Tumor Thrombus in Sarcoma

TL;DR

This study finds that children with sarcoma and tumor thrombus have very low survival rates, highlighting the need for better diagnostic imaging and treatment strategies.

Contribution

The paper provides the first detailed analysis of survival outcomes in pediatric sarcoma patients with tumor thrombus, revealing a 30.8% survival rate after thrombus diagnosis.

Findings

Thirteen pediatric patients with sarcoma and tumor thrombus had a median survival of 15.2 months after thrombus diagnosis.

Osteosarcoma was the most common subtype, and tumor thrombus was often noncontiguous from the primary tumor.

Surgical intervention did not improve long-term survival in this patient group.

Abstract

Background/Objectives: Tumor thrombus is an uncommon but serious finding in sarcoma, with limited pediatric data. While adult cases indicate a median survival of ~14 months, outcomes in children remain poorly understood. Methods: A retrospective review (1990–2025) was conducted at a single pediatric tertiary center. Patients <18 years with pathologically confirmed bone or soft tissue sarcoma and radiographic or histologic evidence of tumor thrombus were included. Minimum follow-up was 3 years or until end of life. The primary outcome was survival after tumor thrombus diagnosis. Results: Thirteen patients (nine males, four females) met the inclusion criteria. The median age at sarcoma diagnosis was 10.5 years. Osteosarcoma was the most common subtype (69.2%), with 76.9% of tumors arising in bone. Disease was localized in 53.8% and metastatic in 46.2% at presentation. Tumor thrombus was contiguous in 61.5% and noncontiguous in 38.5%. The median time from sarcoma diagnosis to death was 44.2 months; from tumor thrombus diagnosis to death, this was 15.2 months. The overall survival after tumor thrombus diagnosis was 30.8%. Conclusions: Pediatric sarcoma with tumor thrombus is associated with poor prognosis, and surgical intervention did not appear to result in long-term survival in this small series. Tumor thrombus may be noncontiguous from the primary tumor, emphasizing the importance of advanced imaging and its implications for treatment planning and counseling.

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