Influence of pathologic fractures on oncologic outcomes in extremity Ewing sarcoma: a single-institution retrospective study

Background Pathologic fractures occur in 5%–10% of patients with Ewing sarcoma and may influence the local treatment strategies. However, their prognostic impact remains unclear. This study evaluated the clinical course of patients with extremity Ewing sarcoma and pathologic fractures using a propensity score-matched analysis. Methods This retrospective single-institution study reviewed 149 patients with extremity Ewing sarcoma treated between 2003 and 2020, including 12 patients (8.1%) with pathologic fractures. For comparison with patients without pathologic fractures, a 1:3 propensity score-matched control group (n = 36, adjusted group) was constructed. Results Among the 12 patients, limb-sparing surgery was performed in 11 patients (91.7%), and limb salvage was finally achieved in 10 patients (83.3%). Three-year overall survival was 75.0% in patients with pathologic fractures, and 78.8% (unadjusted, P = .62) and 82.0% (adjusted, P = .60) in patients without pathologic fractures. Local recurrence was observed in two patients (16.7%) in the pathologic fracture group; both had a poor histologic response. Conclusions In this cohort, pathologic fractures were not associated with a statistically significant difference in oncological outcomes. Limb-sparing surgery may be considered in selected patients, particularly when preoperative treatment is effective. However, the small number of the patients with the fracture limits statistical power and generalizability of the results.