Trends in Tumor Site-Specific Survival of Bone Sarcomas from 1980 to 2018: A Surveillance, Epidemiology and End Results-Based Study

Abstract

Objectives: As diagnosis and treatment guidelines for bone sarcomas continue updating, it is important to examine whether, when, and which kinds of patients have had a survival improvement over the last four decades. Methods: This cohort study included 9178 patients with primary bone and joint sarcomas from 1 January 1980 to 31 December 2018 using data from Surveillance, Epidemiology and End Results (SEER)-9 Registries. The follow-up period was extended to November 2020. Patients were divided by decade into four time periods: 1980–1989, 1990–1999, 2000–2009, and 2010–2018. The primary endpoint was bone sarcomas-specific mortality (CSM). The 5-year bone sarcomas-specific survival (CSS) rate was determined stratified by demographic, neoplastic, temporal, economic, and geographic categories. The associations between time periods and CSM were examined using a multivariable Cox regression model, with reported hazard ratio (HR) and 95% confidence interval (CI). Results: The 5-year CSS rate for bone sarcomas was 58.7%, 69.9%, 71.0%, and 69.2%, in the 1980s, 1990s, 2000s, and 2010s, respectively. Older age, male gender, tumor sites at pelvic bones, sacrum, coccyx and associated joints, as well as vertebral column, osteosarcoma and Ewing tumor, and residence in non-metropolitan areas were independently associated with higher CSM risk. After adjusting for the covariates above, patients in the 1990s (HR = 0.74, 95% CI = 0.68–0.82), 2000s (HR = 0.71, 95% CI = 0.65–0.78), and 2010s (HR = 0.68, 95% CI = 0.62–0.76) had significantly lower CSM risks than patients in the 1980s. However, patients in the 2000s and 2010s did not have lower CSM risks than those in the 1990s (both p > 0.05). Conclusions: Although bone sarcomas survival has significantly improved since 1990, it almost halted over the next three decades. Bone sarcomas survival should improve over time, similar to common cancers. New diagnostic and therapeutic strategies such as emerging immune and targeted agents are warranted to overcome this survival stalemate.

Challenges of Systemic Therapy Investigations for Bone Sarcomas

“…Since the 1970s, the development of cytotoxic chemotherapy has provided improvements in the prognoses of bone sarcoma patients, especially for those with osteosarcoma or Ewing sarcoma. After the 2000s, however, the prognoses of bone sarcoma patients have remained at a plateau, though many new targeted drugs and immunotherapies have been established for cancer therapy [ 7 ].…”

Computer-Aided Design and 3D Printing of Hemipelvic Endoprosthesis for Personalized Limb-Salvage Reconstruction after Periacetabular Tumor Resection

“…The pelvis is the most common anatomic site at which malignant bone tumors occur, whether primary or metastatic. It is reported that approximately 16.2% of primary bone sarcomas are located in the pelvis, e.g., pelvic chondrosarcoma, osteosarcoma, or Ewing tumor, causing a poor five-year survival rate of 45.0~57.5% [ 1 ]. The pelvic bone is also a common destination of many major metastatic cancers, such as lung and breast cancers [ 2 ].…”

Subtype Classification and Prognosis Signature Construction of Osteosarcoma Based on Cellular Senescence-Related Genes

“…Bone sarcoma is a rare component of malignant solid tumors, which are divided into a variety of histological types, including osteosarcoma (OS), chondrosarcoma, Ewing sarcoma, and chordoma which are the most common types of bone malignancies [ 1 ]. Distinct histological sarcomas have different clinical characteristics and results [ 2 ]. OS is one of the most common bone malignancies, accounting for 20% and 40% of all bone cancers, and is highly heterogeneous in terms of histological type, tumor site, and age of onset [ 2 , 3 ].…”

“…Distinct histological sarcomas have different clinical characteristics and results [ 2 ]. OS is one of the most common bone malignancies, accounting for 20% and 40% of all bone cancers, and is highly heterogeneous in terms of histological type, tumor site, and age of onset [ 2 , 3 ]. Patients with local OS can achieve a 5-year survival rate of more than 70% through surgery combined with neoadjuvant and postoperative chemotherapy [ 4 ].…”