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Primary spinal bone sarcomas in Japan: a nationwide comparative analysis of demographic and pathologic features,
Yu Toda1, Koichi Ogura2, Chigusa Morizane1
1National Cancer Center Hospital, Tokyo, Japan.
Purpose:
Primary spinal bone sarcoma (BS) is a rare malignancy accounting for less than 5% of all bone tumors, and direct comparisons between spinal and non-spinal BS remain limited, particularly in Asian populations. We aimed to compare demographic and pathologic characteristics, treatment patterns, and overall survival (OAS) between primary spinal and non-spinal BS, and to identify prognostic factors within the spinal BS cohort.
Methods:
In this retrospective cohort study based on the Japanese National Cancer Registry (NCR), we identified patients with primary BS diagnosed between 2016 and 2019. Spinal and non-spinal BS were compared for demographic and pathologic characteristics, treatment patterns, and OAS using chi-square tests, Kaplan-Meier analysis, and Cox proportional hazards models.
Results:
Among 3,755 patients with BS, 356 (9.5%) had spinal tumors. Compared with non-spinal BS, patients with spinal BS were significantly older (P < 0.001), more frequently presented with advanced disease (P < 0.001), and were less often managed at specialist (Japanese Orthopaedic Association-certified) centers (P = 0.002). Surgery was performed less frequently (33% vs. 68%, P < 0.001) and radiotherapy more often (54% vs. 19%, P < 0.001) in the spinal cohort. The 3-year OAS was significantly poorer in the spinal group (45% vs. 69%, P < 0.001). Within the spinal BS cohort, osteosarcoma was associated with significantly worse OAS than chordoma (hazard ratio [HR] 5.98; 95% confidence interval [CI] 1.71-20.96; P = 0.005), and distant disease at diagnosis predicted worse OAS than localized disease (HR 3.54; 95% CI 1.84-6.81; P < 0.001).
Conclusion:
Primary spinal BS in Japan differs substantially from non-spinal BS in clinical profile, treatment, and prognosis. Histological subtype and disease extent were the strongest independent prognostic factors. These nationwide real-world data offer a benchmark for risk stratification and may inform future treatment strategies for this rare disease.
