Risk Factors for Metastasis at Initial Diagnosis With Ewing Sarcoma

Abstract

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.

Lung Metastasis Probability in Ewing Sarcoma: A Nomogram Based on the SEER Database

“…Lung metastasis in patients with ES can be affected by multiple risk factors [ 11 , 15 , 21 , 22 , 23 ]. Pathways related to platelet-derived growth factor (PDGF) signaling, Wnt signaling, apoptosis signaling, TP53, Notch signaling, and angiogenesis have been found to be of importance for the occurrence and development of metastasis in ES.…”

“…However, the clinical risk factors that affect lung metastasis in patients with ES have not been fully described. Previous clinical studies have mainly investigated all metastasis rather than lung metastasis at initial diagnosis [ 11 , 15 ]. In addition, previous studies did not integrate these factors, instead focusing on a single predictive index, which may have a limited effect on predicting an individual instance of lung metastasis.…”

“…As an independent risk factor, the influence of age on metastasis has been investigated in previous research findings. Ye et al reported that ES patients between 18 and 59 years old had a high likelihood of metastatic disease at initial diagnosis [ 11 ]. Karski et al and Ramkumar et al found that advanced age may increase the metastasis probability of ES [ 26 , 27 ].…”

“…Although patients with lung metastasis alone have better survival than those with metastases at other sites, their mortality at 5 years is still approximately 60–70% [ 7 , 8 , 9 , 10 ]. The survival outcomes of patients with multiple metastases within the lung are even worse [ 11 ]. The early and accurate diagnosis of metastasis is of great significance for the targeted treatment of ES [ 12 ].…”

“…Some studies have investigated potential risk factors for metastasis to facilitate early diagnosis [ 11 , 15 ]. However, these studies analyzed only as single factor to evaluate metastasis in patients with ES.…”