Key result
Pelvic primary lesions were associated with a significantly higher risk of distant metastasis at diagnosis compared to limb lesions (OR 2.492).
Why the study?
To determine the risk factors for metastasis, explore clinicopathological factors associated with poor prognosis, and develop a nomogram to predict overall survival and cancer-specific survival in Ewing sarcoma patients.
What are the clinicopathological risk factors for metastasis and poor prognosis in patients with Ewing sarcoma?
Cohort (n=1,160)
Yes
What are the clinicopathological risk factors for metastasis and poor prognosis in patients with Ewing sarcoma?
Odds Ratio: 2.492 (95% CI 1.829–3.395)
p-value: p=<0.001
Older age, larger tumor size, pelvic lesions, black race, and wider tumor extension are significant risk factors for metastasis and poor survival in Ewing sarcoma.
Pelvic primaries may warrant enhanced metastatic staging in Ewing sarcoma; leaves open whether risk-adapted interventions improve outcomes.
BACKGROUND: This study is to determine the risk factors for metastasis of Ewing sarcoma (ES) patients in SEER database. Then explore clinicopathological factors associated with poor prognosis. Furthermore, develop the nomogram to predict the probability of overall survival and cancer-specific survival METHODS: Thus, we collected clinicopathological data of ES patients in SEER database, and then used chi-square test and logistic regression to determine risk factors associated to metastasis. We also did survival analysis including Kaplan-Meier curve and Cox proportional hazard model to explore the risk factors associated to overall survival and cancer-specific survival, and then developed the nomogram to visualize and quantify the probability of survival. RESULTS: After statistics, we find that patients with older ages (11-20 years old: OR = 1.517, 95% confidence interval [CI] 1.033-2.228, p = 0.034; 21-30 years old: OR = 1.659. 95%CI 1.054-2.610, p = 0.029), larger tumor size (> 8 cm: OR = 1.914, 95%CI 1.251-2.928, p = 0.003), and pelvic lesions (OR = 2.492, 95%CI 1.829-3.395, p < 0.001) had a higher risk of metastasis. ROC curves showed higher AUC (0.65) of combined model which incorporate these three factors to predict the presence of metastasis at diagnosis. In survival analysis, patients with older ages (11-20 years: HR = 1.549, 95%CI 1.144-2.099, p = 0.005; 21-30 years: HR = 1.808, 95%CI 1.278-2.556, p = 0.001; 31-49 years: HR = 3.481, 95%CI 2.379-5.094, p < 0.001; ≥ 50 years: HR = 4.307, 95%CI 2.648-7.006, p < 0.001) , larger tumor size (5-8 cm: HR = 1.386, 95%CI 1.005-1.991, p = 0.046; > 8 cm: HR = 1.877, 95%CI 1.376-2.561, p < 0.001), black race (HR = 2.104, 95%CI 1.296-3.416, p = 0.003), and wider extension (regional: HR = 1.373, 95%CI 1.033-1.823, p = 0.029; metastatic: HR = 3.259, 95%CI 2.425-4.379, p < 0.001) were associated with worse prognosis. Chemotherapy was associated with better prognosis (HR = 0.466, 95%CI 0.290-0.685, p < 0.001). The nomogram which developed by training set and aimed to predict OS and CSS showed good consistency with actual observed outcomes internally and externally. CONCLUSION: In conclusion, tumor size and primary site were associated with distant metastasis at diagnosis. Age, tumor size, primary site, tumor extent, and chemotherapy were associated with overall survival and cancer-specific survival. Nomogram could predict the probability of OS and CSS and showed good consistency with actual observed outcomes internally and externally.
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Shi et al. (2020) conducted a cohort in Ewing sarcoma (n=1,160). Pelvic primary site vs. Limb primary site was evaluated on Distant metastasis at diagnosis (OR 2.492, 95% CI 1.829-3.395, p=<0.001). Pelvic primary lesions were associated with a significantly higher risk of distant metastasis at diagnosis compared to limb lesions (OR 2.492).
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