Pediatric Bone Sarcomas: A Single-Center Experience in Jordan

Osteosarcoma and Ewing sarcoma are the most common primary malignant bone tumors in children and adolescents. This study aimed to characterize the demographic, clinicopathologic, treatment, and survival features of pediatric patients with these malignancies at a tertiary referral center in Jordan.

This retrospective cohort study included all patients aged 18 years or younger with histologically confirmed osteosarcoma or Ewing sarcoma treated at Queen Rania Al Abdullah Hospital for Children, Amman, Jordan, between January 2015 and December 2025. Data were extracted regarding patient demographics, clinical presentation, laboratory biomarkers, treatment protocols, and clinical outcomes. Descriptive statistics and binary logistic regression were utilized to identify predictors of relapse and mortality.

The study cohort comprised 52 patients (mean age 10.5 years) of whom 30 (57.7%) were male. Ewing sarcoma accounted for 75% of cases (n=39), and osteosarcoma for 25% (n=13). During the study period, nine (17.3%) patients experienced relapse, and 13 (25%) succumbed to the disease. Multivariable logistic regression analysis was performed to identify predictors of relapse and mortality. No statistically significant predictors of relapse were identified in this cohort. Specifically, metastatic disease at diagnosis (OR 9.67; 95%CI, 2.21-42.33; p = 0.003) and positive surgical margins (OR 0.089 for negative vs positive margins; 95%CI, 0.015-0.538; p = 0.008) were both significantly associated with increased mortality.

In this single-center cohort, a high frequency of metastatic disease at presentation and positive surgical margins were strongly associated with increased mortality. These findings underscore the critical need for earlier clinical detection and for implementing robust local control strategies. Improving these elements of the care pathway is essential to enhancing survival outcomes in pediatric orthopedic oncology within the region.