Risk factors for detectable metastatic disease at presentation in Ewing sarcoma – An analysis of the SEER registry

Ramkumar, Dipak B.; Ramkumar, Niveditta; Miller, Benjamin J.; Henderson, Eric

doi:10.1016/j.canep.2018.10.013

Cited by 18 publications

(22 citation statements)

References 36 publications

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“…It is challenging to include a large cohort to investigate the patterns of DM for this patient subset. Several studies from the SEER program have investigated the survival outcome of primary metastatic ES [7] , [8] , [23] . However, the patterns of DM were not analyzed in these studies [7] , [8] , [23] .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies from the Several Surveillance, Epidemiology, and End Results (SEER) studies had found several predictive indicators related to the increased risk of detectable metastatic disease in ES, including older age, larger tumor diameter, and axial tumor location [7] , [8] . Moreover, the prognostic factors affecting the prognosis of metastatic ES have been identified in several studies, including older age, larger tumor volume, axial tumor location, and the rise of serum lactate dehydrogenase [9] , [10] , [11] .…”

Section: Introductionmentioning

confidence: 99%

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The patterns of distant metastasis and prognostic factors in patients with primary metastatic Ewing sarcoma of the bone

Zhang

Xiong

et al. 2021

Journal of Bone Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The patterns of distant metastasis and prognostic factors in patients with primary metastatic Ewing sarcoma of the bone

Zhang

Xiong

et al. 2021

Journal of Bone Oncology

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“…Previous researches have demonstrated that metastasis at initial diagnosis was an independent predictive factor of poorer overall survival (7, 10–13). Ramkumar et al found that advanced age, axial tumor location, and larger tumor size were associated with increased odds of detectable metastatic disease at initial diagnosis in patients with Ewing family of tumors (EFT) (14). The current study investigated specifically bone Ewing sarcoma rather than the EFT.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Metastasis at Initial Diagnosis With Ewing Sarcoma

Dai

Zhang

2019

Front. Oncol.

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Purpose: We aimed to identify potential risk factors predictive of metastasis at initial diagnosis in Ewing sarcoma patients.Patients and methods: We enrolled selected patients diagnosed with Ewing sarcoma between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) Program database. Demographic and clinical features of patients were analyzed to demonstrate the potential risk factors of distant metastasis at presentation. We utilized descriptive statistics, univariate methods, and a series of regression models to analyze the significance of risk factors. Moreover, we conducted survival analysis in patients with different metastatic sites through Kaplan–Meier analysis.Results: We identified 1,066 cases of Ewing sarcoma and 332 (31.1%) of the patients had metastasis at initial diagnosis. In the univariate logistic regression analysis, patients had higher probability of metastasis at initial diagnosis if they aged between 18 and 59 years old (OR = 1.43; 95% CI, 1.09 to 1.86), had a tumor located in the axial or cranial bones (OR = 1.38; 95% CI, 1.05 to 1.81), or had a tumor over 8 cm (OR = 2.55; 95% CI, 1.66 to 3.89). These three factors were still significant when analyzed in a multivariate logistic regression model or another multivariate logistic regression model controlling for age, location, and tumor size, which had univariate p < 0.1. Besides, we found that patients with lung metastasis alone had a better prognosis than patients with bone metastasis alone or with two or more metastatic sites (p < 0.01).Conclusion: Ewing sarcoma patients with an age between 18 and 59 years old, a tumor in the axial or cranial bones, and a tumor size over 8 cm had an increased likelihood to have metastatic diseases at initial diagnosis.

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“…1 Approximately 10% to 30% of patients with sarcoma present with detectable metastases at initial diagnosis, depending on subtype. [2][3][4] Those with metastatic disease at diagnosis experience poorer outcomes than those with localized disease, with overall 5-year survival rates ranging from 10% to 30% for those with metastases and 65% to 80% for those without metastases. [5][6][7][8][9] Sarcomas cause few early recognizable signs and symptoms that can often lead to an extended delay between symptom onset and a definitive diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…[10][11][12][13] A lower socioeconomic status (SES) may be representative of factors at the individual or community level that prevent patients from receiving timely access to medical care 14,15 and has been associated with advanced stage at diagnosis of more common cancers, including those of the breast, prostate, colorectal, lung, and cervix. 16 Prior analyses 2,3 of the effect of SES on the diagnosis of sarcoma in the US are few and largely based on county-level analyses of SES, which may have introduced bias, considering that counties may comprise economically heterogeneous populations.…”

Section: Introductionmentioning

confidence: 99%

Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis

et al. 2020

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IMPORTANCE Approximately 10% to 30% of patients with sarcoma present with detectable metastases at diagnosis. However, the extent to which presentation with metastases is due to delayed diagnosis vs other factors remains unclear. OBJECTIVE To evaluate whether socioeconomic status, insurance status, or race/ethnicity were associated with the presence of metastases at diagnosis of sarcoma. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the populationbased Surveillance, Epidemiology, and End Results program. Adult and pediatric patients with an initial diagnosis of soft-tissue and bone sarcoma between 2001 and 2015 were stratified by age group (pediatric, <20 years; adult, 20-65 years; older adult, >65 years) and sarcoma subtype. Statistical analyses were performed between August 2019 and January 2020. EXPOSURES Surveillance, Epidemiology, and End Results Census tract-level socioeconomic status index, insurance status, and race/ethnicity. MAIN OUTCOMES AND MEASURES The odds of presenting with metastases at diagnosis were calculated. RESULTS A total of 47 337 patients with first primary malignant sarcoma were included (24 343 male patients [51.4%]), with 29 975 non-Hispanic White patients (63.3%), 5673 non-Hispanic Black patients (12.0%), 7504 Hispanic patients (15.8%), and 4185 American Indian-Alaskan Native and Asian Pacific Islander patients (8.8%). Liposarcoma in adults was the only subtype and age group combination that demonstrated a significant trend in incidence across socioeconomic status levels (odds ratio, 0.85; 99% CI, 0.76-0.96; P = .001). However, compared with having non-Medicaid insurance, having Medicaid or no insurance in adults was associated with an increased odds of metastases at diagnosis for 6 of the 8 sarcoma subtypes evaluated; osteosarcoma and Ewing sarcoma were the only 2 subtypes in adults for which metastases were not associated with insurance status. In addition, there was an increased risk of presenting with metastases among non-Hispanic Black adults diagnosed with leiomyosarcoma (odds ratio, 1.87; 99% CI, 1.41-2.48) and unclassified sarcomas (odds ratio, 1.65; 99% CI, 1.01-2.67) compared with non-Hispanic White adults that was independent of socioeconomic and insurance status. CONCLUSIONS AND RELEVANCE These findings suggest that delayed access to care is associated with advanced stage at diagnosis for several soft-tissue sarcoma subtypes in adults, whereas other factors may be associated with the metastatic progression of osteosarcoma and Ewing sarcoma, as well as the racial disparities observed with metastatic leiomyosarcoma and unclassified sarcomas.

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Risk factors for detectable metastatic disease at presentation in Ewing sarcoma – An analysis of the SEER registry

Cited by 18 publications

References 36 publications

The patterns of distant metastasis and prognostic factors in patients with primary metastatic Ewing sarcoma of the bone

The patterns of distant metastasis and prognostic factors in patients with primary metastatic Ewing sarcoma of the bone

Risk Factors for Metastasis at Initial Diagnosis With Ewing Sarcoma

Associations of Socioeconomic Status, Public vs Private Insurance, and Race/Ethnicity With Metastatic Sarcoma at Diagnosis

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