Treatment outcomes in patients with Ewing sarcoma of the spine in a resource-challenged setting: 17-year experience from a single center in India

Abstract

Ewing sarcoma (ES) of the spine is a rare childhood cancer with sparse literature on treatment outcomes. We aimed to describe survival outcomes and prognostic factors in patients with spinal ES treated at a single institute in a resource-challenged setting. We conducted a retrospective analysis of patients with spinal ES registered at a tertiary care oncology center between 2003–2019. Clinical patient data was retrieved from hospital records. Cox regression analysis was used to identify the association of baseline clinical parameters with event free survival (EFS) and overall survival (OS). A cohort of 85 patients was analyzed including 38 (45%) patients with metastatic disease. The median age was 15 years with 73% being male. Local therapy was administered in 62 (72.9%) patients with surgery alone in 8 (9.4%), radiotherapy alone in 36 (42.4%) and both in 18 (21.2%) patients. A higher proportion of males received local therapy than females (80.3% versus 59.1%; p = 0.049). The median EFS and OS were 20.1 and 28.6 months, respectively. On univariable analysis, age ≤ 15 years, female sex, serum albumin ≤3.5 g/dL and hemoglobin ≤11 g/dL were associated with inferior EFS while younger age, female sex, hypoalbuminemia and metastatic disease were associated with inferior OS. On multivariable analysis, only hypoalbuminemia was predictive for inferior EFS (HR:2.41; p = 0.005) while hypoalbuminemia (HR:2.06;p = 0.033) and female sex (HR:1.83; p = 0.046) were associated with inferior OS. We concluded that hypoalbuminemia confers poor prognosis in ES spine. Survival outcomes are poorer in females treated in our setting, possibly due to prevailing sex-based biases.

Keywords:

• Ewing sarcoma
• primitive neuroectodermal tumor
• prognostic factors
• resource challenged
• spine

Acknowledgments

The authors acknowledge every member of the paediatric oncology team of our centre including research staff, nurses and dietician for their exemplary clinical services. In particular, the contributions of Ms Mamta Kumari, who maintains and updates the patient database and Ms Deepa Dhawan who has played a major role in the coordination of data collection are well appreciated.

Authors’ contributions

Archana Sasi and Sindhura Chitikela conceptualized the study, compiled and analyzed the data, interpreted results and wrote the manuscript. Shuvadeep Ganguly interpreted results and wrote the manuscript. Bivas Biswas conceptualized the study, compiled the data and edited the manuscript. Deepam Pushpam, Akash Kumar, Shah Alam Khan, Venkatesan Sampath Kumar, Shashank Sharad Kale, Ahitagni Biswas, Adarsh Barwad, Asit Ranjan Mridha and Sanjay Thulkar conceptualized the study, provided intellectual inputs, administrative support and edited the manuscript. Sameer Bakhshi conceptualized the study, provided administrative support, intellectual inputs, interpreted results, wrote and edited the manuscript. All authors have reviewed and approved the final version of the manuscript.

Disclosure statement

All authors declare no potential conflicts of interest.

Data availability statement

The data that supports the findings of the study are available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.