Disparate Outcomes, Biologic and Therapeutic Differences in Pediatric versus Adult Patients with Ewing Sarcoma

Victoria Wytiaz; Eric Schwartz; John D Rice; Lili Zhao; Rama Jasty; Scott Schuetze; Rashmi Chugh

doi:10.1159/000533412

Disparate Outcomes, Biologic and Therapeutic Differences in Pediatric versus Adult Patients with Ewing Sarcoma

Oncology. 2024;102(1):1-8. doi: 10.1159/000533412. Epub 2023 Aug 18.

Authors

Victoria Wytiaz¹, Eric Schwartz², John D Rice³, Lili Zhao³, Rama Jasty⁴, Scott Schuetze⁵, Rashmi Chugh⁵

Affiliations

¹ Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA, wytiazv@umich.edu.
² Oncology, Colorado Permanente Medical Group, Denver, Colorado, USA.
³ Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Division of Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.

PMID: 37598679
DOI: 10.1159/000533412

Abstract

Introduction: Ewing sarcoma (ES) is a small blue round cell sarcoma affecting a wide age spectrum. Clinical advances predominately stem from pediatric research consortia clinical trials. In most series, adults have poorer outcomes when compared to children. The aim of this study was to perform a detailed evaluation of factors potentially accounting for this difference.

Methods: A single institution retrospective chart review was conducted on patients with ES diagnosed from 2005 to 2015, identified using a free-text search engine with the keywords "Ewing sarcoma" as well as a corresponding pathologic database. Data were analyzed based on age, pediatric (age <18) and adult (age >18 years), using a multivariate analysis model.

Results: Eighty-eight ES patients (34 pediatric, 54 adult) were identified with a median age of 13 (range 3-18) and 31 (range 19-70) in their respective cohorts. Five-year overall survival (OS) was higher in pediatric patients (73.5% vs. 48.1%, p = 0.0213). By stage, 5-year OS in pediatric versus adult patients was 65% versus 20% (p = 0.0530) in metastatic (n = 32) and 68.1% versus 58.8% (p = 0.278) in localized (n = 56) patients. Lung-only metastases were present in 83% of metastatic pediatric patients versus 35% of adult metastatic patients. Pediatric patients received more cycles of first-line chemotherapy (13.8 vs. 11.4, p = 0.001), independent of stage. More cycles of chemotherapy correlated with improved OS (HR: 0.864, CI: 0.773-0.967) and progression-free survival (HR: 0.897, CI: 0.808-0.996).

Conclusions: Outcome differences were most notable in patients with metastatic disease, although not statistically significant. Our series found differences in presentation between pediatric and adult populations with adult patients receiving fewer cycles of chemotherapy. This may suggest that both variations in underlying disease biology and potentially differences in treatment may account for outcome disparities.

Keywords: Adult; Cancer biology; Ewing sarcoma; Metastatic disease; Outcomes; Pediatric patients.

MeSH terms

Adolescent
Adult
Biological Products* / therapeutic use
Bone Neoplasms* / drug therapy
Bone Neoplasms* / pathology
Child
Humans
Lung Neoplasms*
Retrospective Studies
Sarcoma*
Sarcoma, Ewing* / drug therapy
Sarcoma, Ewing* / pathology

Substances

Biological Products