Effects of different treatments and other factors on the prognosis of patients with ewing sarcoma

BACKGROUND: Ewing sarcoma is a small round cell tumor of bone or soft tissue originating from the neuroectoderm. Aggressive and highly malignant are the main pathological features of the tumor. Studying the effects of different treatments and other factors on prognosis will help us to understand the disease more deeply and find a way to actively deal with it. METHODS: Through the search of the National Cancer Institute database, ewing sarcoma patients registered between January 1, 2004 and December 31, 2015 were selected as research goals. Summarize the basic information of patients included in the study, including demographics, tumor pathology and treatment. Kaplan–Meier survival curves and log-rank test were used to analyze the overall survival (OS) and ewing sarcoma-specific survival (ESSS) of each prognostic factor and categorical variable. Multivariate Cox regression analysis was used to analyze all-cause mortality (ACM) and ewing sarcoma-specific mortality (ESSM) for each prognostic factor and categorical variable. RESULTS: A total of 837 ewing sarcoma patients were included in this article. Patients receiving chemotherapy (CT), radiotherapy (RT) or surgery were 804 (96.1%), 414 (49.5%), and 524 (62.6%). The mean age and median age of 837 patients were 19.92 and 16 years, respectively. The mortality rate gradually increased with the increase of the age at diagnosis (ACM: 50.6% vs. 45.3% vs. 25.7%, P<0.001; ESSM: 44.0% vs. 43.0% vs. 25.1%, P<0.001). Married patients’ mortality was significantly higher than unmarried patients (ACM: 53.2% vs. 31.2%, P<0.001; ESSM: 29.8% vs. 48.5%, P<0.001). CT combined surgery achieved the highest OS and ESSS. Observing clinical pathology data, the primary site of the tumor located in pelvic bones, sacrum coccyx and associated joints, which had the highest mortality (ACM: 45.3%; ESSM: 43.9%). The mortality of tumors classified as American Joint Committee on Cancer (AJCC) III–IV stage was significantly higher than that of AJCC IIA and AJCC IIB stage, and the mortality increased with the higher AJCC stage (ACM: 53.0% vs. 31.3% vs. 21.0%, P<0.001; ESSM: 51.2% vs. 30.1% vs. 18.6%, P<0.001). The mortality of T2–T3 stage was significantly higher than that of T0–T1 stage (ACM: 40.7% vs. 27.0%, P<0.001; ESSM: 39.1% vs. 24.8%, P<0.001). N1 stage was significantly higher than N0 (ACM: 49.2% vs. 32.8%, P=0.008; ESSM: 49.2% vs. 30.7%, P=0.002). M1 stage was significantly higher than M0 stage (ACM: 56.8% vs. 25.5%, P<0.001; ESSM: 55.2% vs. 23.5%, P<0.001). Compared with other treatments, patients who received CT and surgery had the lowest ACM (21.7%) and ESSM (20.9%), and the mean survival (59.90±39.24 months) and median survival (53 months) were the longest. CONCLUSIONS: From the demographic and tumor pathology data, the older patients at the age of diagnosis, married, the primary sites in the pelvic bones, sacrum coccyx and associated joints, American Joint Committee on Cancer (AJCC) III–IV, T2–T3, N1 and M1 stage tumors are all prompted to patients’ poor prognosis. Compared with CT, CT and RT, or CT and RT and surgery, ewing sarcoma patients receiving CT combined with surgery have the longest median survival, the lowest mortality, and the best prognosis.