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Published on: December 9, 2016
[Analysis of 41 cases of non-metastatic Ewing's sarcoma in children]
Insights
This study found that complete surgical resection and early local treatment improve outcomes for children with non-metastatic Ewing sarcoma (ES). Incomplete resection is a significant risk factor for poor prognosis in pediatric ES patients.
Area of Science:
- Pediatric Oncology
- Skeletal System Neoplasms
- Chemotherapy
Context:
- Ewing sarcoma (ES) is a rare bone cancer primarily affecting children and adolescents.
- Non-metastatic ES requires effective treatment strategies to improve patient survival and reduce long-term complications.
- Understanding prognostic factors is crucial for tailoring treatment and improving outcomes in pediatric ES.
Purpose:
- To analyze clinical characteristics, treatment outcomes, and prognostic factors in children with non-metastatic Ewing sarcoma (ES).
- To evaluate the effectiveness of a comprehensive treatment approach including chemotherapy, surgery, and radiotherapy.
- To identify independent risk factors influencing prognosis in pediatric ES patients.
Summary:
- A retrospective analysis of 41 children with non-metastatic ES treated between 2010-2018 revealed 5-year event-free survival (EFS) of 78% and overall survival (OS) of 82%.
- Univariate analysis identified tumor diameter ≥8 cm, delayed local treatment (≥16 weeks), and incomplete surgical resection as negative prognostic indicators.
- Multivariate analysis confirmed incomplete surgical resection as an independent risk factor (HR=8.381, P=0.010) for poor prognosis in pediatric ES.
Impact:
- Comprehensive treatment integrating chemotherapy, surgery, and radiotherapy significantly improves outcomes for children with ES.
- Complete surgical resection and timely initiation of local treatment are key to enhancing survival rates.
- Identifying prognostic factors like tumor size and resection status aids in personalized treatment planning for pediatric Ewing sarcoma.
Objectives:
To summarize the clinical characteristics, treatment outcomes, and prognostic factors of children with non-metastatic Ewing's sarcoma (ES).
Methods:
A retrospective analysis was conducted on the clinical data of 41 children with non-metastatic ES diagnosed and treated at the Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 2010 to December 2018. All patients underwent chemotherapy based on the RMS-2009 protocol of the center, and local treatment such as surgery and/or radiotherapy was performed according to risk grouping. The Kaplan-Meier method was used to calculate the overall survival (OS) and event-free survival (EFS) rates. Univariate prognostic analysis was performed using the log-rank test, and multivariate analysis was conducted with Cox regression.
Results:
Of the 41 children, 21 were male and 20 were female. The median age at diagnosis was 7.7 years (range: 1.2-14.6 years). The median follow-up time for patients with event-free survival was 68.1 months (range: 8.1-151.7 months). As of the last follow-up, 33 patients were in complete remission, and the overall 5-year EFS and OS rates were (78±6)% and (82±6)%, respectively. Univariate analysis by the log-rank test showed that a tumor diameter ≥8 cm, time from diagnosis to start of local treatment ≥16 weeks, and incomplete surgical resection were associated with poor prognosis (P<0.05). Multivariate Cox regression analysis indicated that incomplete surgical resection (HR=8.381, 95%CI: 1.681-41.801, P=0.010) was an independent risk factor for poor prognosis in children with ES. Secondary tumors occurred in 2 cases.
Conclusions:
A comprehensive treatment strategy incorporating chemotherapy, surgery, and radiotherapy can improve the prognosis of children with ES. Poor prognosis is associated with an initial tumor diameter ≥8 cm, while complete surgical resection and early initiation of local treatment can improve outcomes.
