Abstract
BackgroundCommon primary bone tumors include osteosarcomas (OSC) and Ewing sarcomas (EWS). The skull is a rare site, and literature about their treatment and survival is scarce. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study aims to assess the treatment and survival of skull OSC and skull EWS, as well as predictors for survival.MethodsSkull OSC and EWS cases were obtained from the SEER database. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using multivariable Cox proportional hazard regression stratified by tumor histology. Kaplan-Meier curves were constructed for OS comparing OSC and EWS, as well as histological subtypes in OSC.ResultsA total of 321 skull OSC and 80 skull EWS patients were registered from 1973 to 2013. EWS was more common in younger patients (p < 0.001). Resection was the predominant treatment strategy (80.1%), frequently in combination with adjuvant radiotherapy (30.4%). The 5-year survival rate varied significantly between OSC and EWS (51.0% versus 68.5%, p = 0.02). Kaplan-Meier curves show that EWS had a significantly better survival compared to OSC. Comparing histological subtypes of skull OSC, chondroblastic OSC had the best OS, Paget OSC the worst. Older age, tumor advancement, no surgical treatment, and the use of radiotherapy were identified as independent predictors of decreased OS in skull OSC.ConclusionOverall prognosis is better for EWS compared to OSC. Chondroblastic OSC have the best overall survival, while OSC associated with Paget’s disease of the bone has the poorest overall survival.
Highlights
Primary malignant bone tumors of the skull are rare entities
Overall prognosis is better for Ewing sarcomas (EWS) compared to OSC
In order to evaluate surgery from all time periods, a single variable was constructed: no surgery (< 1998 codes: 00, 01; for 1998 +: 00), partial resection (< 1998: 02, 10, 20, A total of 401 patients were identified in the SEER database: 321 patients with skull osteosarcomas (OSC) (80.0%) and 80 patients with skull Ewing sarcomas (EWS) (20.0%, Table 1)
Summary
Primary malignant bone tumors of the skull are rare entities. Osteosarcomas (OSC) and Ewing sarcomas (EWS) are common primary bone tumors which can affect the skull. OSC are the most common malignant tumors of the bone, with a peak incidence in adolescence during the growth spurt [27]. They can arise after radiotherapy, in Paget’s disease of the bone, and in several hereditary diseases [6, 27]. EWS are the second most common primary bone malignancies in children [45] They typically occur in children and adolescents, and in adults [27, 45]. Using the Surveillance, Epidemiology, and End Results (SEER) database, this study aims to assess the treatment and survival of skull OSC and skull EWS, as well as predictors for survival
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