Outcome of surgical treatment of children and adolescents with primary malignant sacral tumours.

Abstract

Little is known about the clinical outcome of children and adolescent patients with primary malignant sacral tumours. We retrospectively reviewed 40 patients with malignant sacral tumours aged ≤ 18years, receiving surgery based on the previous proposed surgical resection classification at our centre from 2003 to 2018. The following data were collected in the present study: age, gender, radiological images, detailed information ofthe surgical procedure, pulmonary and other metastasis at presentation, complications, local recurrence, metastasis, and death during the follow-up were recorded from the clinical and follow-up files. The mean follow-up was 30.7months (range, 5.2-146.7months). The incidence of local recurrence was 27.5% (11/40). Seven cases had surgical site infection andthere were 12cases of wound dehiscence. One had a deep venous thrombosis and one had femoral artery thrombosis. Three had fixation breakage and then received a revision. Tenty-two patients (22/40, 55%) were free of disease. A total of 13 deaths (13/40, 32.5%) were observed and the mean overall survival period was 17.1months (range, 6.3-34.2months), and a pulmonary metastasis occurred in 18 patients (45%, 18/45) at the 12.0 ± 10.3months (range, 2.2-35.3months) after initial surgery. The overall survival rates at one, two and five years were respectively 88.3%, 62.5%, and 51.9%. In the stratification analysis of young patients with primary malignant tumours at the sacrum after surgery, it revealed the influence of pathological grade, location, and age on the oncological outcomes. Kaplan-Meier estimateda survivorship curve of patients with high and low-grade malignant tumoursand showed statistical differences in the overall survival and distant relapse-free survival rates between two groups. Afterwards, the result demonstrated that paediatric patients aged ≤ 14years had worse prognosis than those aged > 14years. It is satisfactory for the outcome of surgical treatment of children and adolescent patients with primary malignant sacral tumours based on proposed surgical classification. Furthermore, paediatric patients aged ≤ 14years have the tendency of poor prognosis compared to adolescent aged > 14years.