Pediatric vs. Adult Cases of Primary Osseous Sarcomas of the Spine: A Population-Based Analysis

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 SEER 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 (HR=1.03; 95% CI=1.01-1.04; p<0.001), an osteosarcoma diagnosis (HR=2.06; CI=1.17–3.61; p=0.0019), and increasing tumor size (HR=1.01, CI=1-1.02, p=0.007) increased mortality risk. For adults, age, an osteosarcoma diagnosis, male sex (HR=1.94; CI=1.07–3.52; p=0.0297) and Black race (HR=3.16; CI=1.07-9.34; p=0.0374) conferred a poor prognosis. Subtotal tumor resection was protective for adults (HR=0.29; CI=0.09–0.92; p=0.0355). For children, only increasing age (HR=1.13; CI=1.03–1.23; p=0.00678) 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 cancer specific survival 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. Population based analysis of spinal osseous sarcomas shows children have improved cancer specific survival versus adults. In adults, osteosarcoma histology and lack of surgery was associated with poor outcomes, while resection was associated with increased survival. Pediatric outcomes were less treatment dependent.