Association of limb-salvage surgery and amputation with survival in Ewing sarcoma of bone: A population-based SEER analysis.

Background

Ewing sarcoma (ES) is a highly aggressive primary bone tumor requiring multimodal therapy. This study aims to provide real-world evidence on the long-term survival impact of different surgical procedures in ES of bone.

Methods

A total of 1202 patients with primary ES of bone were identified from the Surveillance, Epidemiology, and End Results database between 2000 and 2021. Survival outcomes were compared across surgical procedures using Kaplan-Meier analysis and Cox regression.

Results

The cohort had a median age of 16 years, with a 5-year overall survival (OS) of 65.3%. Surgical procedures included limb-salvage surgery (LSS) for 36.9% of patients, local excision (LE) for 16.1%, and amputation (AMP) for 7.3%. Patients treated with LSS achieved favorable outcomes, with a 5-year OS of 77.0%. In the multivariable analysis, survival following LSS did not significantly differ from AMP (HR = 1.356, 95% CI: 0.906-2.029, p = 0.139), whereas LE (HR = 1.424, 95% CI: 1.045-1.941, p = 0.025) and lack of surgery (HR = 1.504, 95% CI: 1.183-1.912, p = 0.001) were independently associated with worse OS. Age ≥ 18 years, tumor size > 80 mm, distant disease, and absence of surgery or chemotherapy remained independent predictors of poorer survival (all p ≤ 0.001).

Conclusion

In this population-based analysis, LSS was associated with favorable survival, showing no significant disadvantage compared with AMP. These findings suggest that LSS may be a reasonable local control option for resectable ES when technically feasible, warranting prospective validation.