What outcomes can be expected after surgical treatment of primary pelvic bone sarcomas in children at referral centers?
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BACKGROUND: Primary pelvic bone sarcomas in children are rare and associated with poor outcomes, but large-volume, multicenter data are lacking. QUESTIONS/PURPOSES: We asked: What is the overall survival of pediatric patients with primary pelvic bone sarcomas following surgical treatment? What are the rates of local recurrence and postoperative complications? Which factors are associated with these outcomes? METHODS: We retrospectively reviewed 119 patients younger than 16 years treated surgically for primary pelvic sarcoma at five referral centers between 1990 and 2023. Survival was estimated with Kaplan-Meier methods, and recurrence and complications with competing risk models. Prognostic factors were analyzed with Cox regression. RESULTS: Estimated survival was 59% at 5-years and 55% at 10-years. Local recurrence occurred in 19% of patients, most within 2 years. Positive margins and poor response to chemotherapy were associated with worse survival and recurrence (p < 0.01), while radiotherapy showed a non-significant trend toward reduced recurrence (p = 0.054). Complications developed in 47% of patients at 5-years, most often wound dehiscence and deep infections. Reconstruction was not significantly associated with complications (p = 0.379). CONCLUSION: Pediatric pelvic sarcomas remain challenging, with poor long-term survival, high recurrence, and frequent complications. Negative margins and good chemotherapy response are the most important prognostic factors. Radiotherapy, particularly in the preoperative setting, may have an expanding role when clear wide margins are not achievable. Multicenter collaboration is essential to optimize treatment strategies and improve outcomes in rare diseases like pelvic bone sarcomas in the pediatric population. LEVEL OF EVIDENCE: Type 3 multicentric study.