# Pediatric versus adult cases of primary osseous sarcomas of the spine: A population-based analysis

## TL;DR

This study compares outcomes of spinal bone cancer in children and adults, finding better survival in children and different treatment impacts by age group.

## Contribution

The study identifies distinct prognostic factors and treatment effects in pediatric versus adult spinal sarcomas using population-based data.

## Key findings

- Children had better cancer-specific survival than adults with spinal sarcomas.
- Adults benefited from subtotal tumor resection, while pediatric survival was not significantly affected by treatment variables.
- Age, tumor type, and race were significant mortality predictors in adults but not in children.

## Abstract

Primary osseous sarcomas of the spine provide a challenge due to their anatomic location and aggressiveness. While chemotherapy, radiation, and surgery are frequently employed as treatments for these neoplasms, their efficacy has not been compared between children and adults.

Using the Surveillance, Epidemiology, and End Results database (2000–2021), 455 patients were identified with confirmed osteosarcoma, Ewing’s sarcoma, or chondrosarcoma. Demographic, tumor, and treatment characteristics were analyzed. Cox proportional hazard models were used to evaluate mortality predictors, and Kaplan–Meier survival analysis was performed.

For the entire cohort, increasing age (hazard ratio [HR]=1.03; 95% confidence interval [CI]=1.01–1.04; p<.001), an osteosarcoma diagnosis (HR=2.06; CI=1.17–3.61; p=.0019), and increasing tumor size (HR=1.01, CI=1–1.02, p=.007) increased mortality risk. For adults, age, an osteosarcoma diagnosis, male sex (HR=1.94; CI=1.07–3.52; p=.0297) and Black race (HR=3.16; CI=1.07–9.34; p=.0374) conferred a poor prognosis. Subtotal tumor resection was protective for adults (HR=0.29; CI=0.09–0.92; p=.0355). For children, only increasing age (HR=1.13; CI=1.03–1.23; p=.00678) decreased survival. Kaplan–Meier analysis revealed cohort-wide median cancer-specific survival (CSS) of 82 months, with 5- and 10-year survival rates of 53% and 47%. Adult median CSS was 34 months, with 5- and 10-year survival rates of 44% and 37%. Median CSS was not reached in the pediatric cohort, with 5- and 10-year CSS rates of 69% and 64%.

Children experienced improved CSS compared to adults. While resections were associated with survival in adults, survival in pediatric patients was not significantly influenced by treatment-related variables. These findings suggest that patient age and histology should guide prognosis and treatment strategy.