Presenting features and overall survival of chondrosarcoma of the pelvis. (2022) - Brown, Jeffrey Mark
Highlights: The present study evaluates the clinical presentation and survival for chondrosarcoma of the pelvis and explores the disparate outcomes of this disease subpopulation relative to chondrosarcoma at other locations. Research was performed on a cohort of 472 patients in the Surveillance, Epidemiology, and end-results database. Chondrosarcoma of the pelvis more frequently presents with known, poor prognostic features, including higher rates of metastasis, larger tumor size, and higher histologic grade relative to chondrosarcoma in other regions. The challenge of wide surgical excision in the pelvis results in a higher percentage of non-operative cases, increased frequency of local recurrence due to poor surgical margins, and high post-operative morbidity. Likewise, pelvic chondrosarcoma carries the worst overall survival relative to other sites. Abstract: Introduction: Chondrosarcoma is the second most common sarcoma of bone. This sarcoma is generally unresponsive to chemotherapy and radiation and is primarily managed through surgical excision. Pelvic chondrosarcoma presents a distinct therapeutic challenge due the complexity of resection, frequent recurrence and metastasis, and high post-operative morbidity. Methods: The SEER database was queried for pelvic chondrosarcoma diagnosed between 2004 and 2015. Cases were described by age, sex, tumor size, extension, grade, metastasis, and therapeutic intervention. These same variables were assessed for the upper extremities, lower extremities, skull and facial bones, thoracic bones, and vertebral column. Results: In total, 472 cases of pelvic chondrosarcoma were identified, representing 18.4% out of 2571 cases of chondrosarcoma distributed throughout the skeletal system. Among pelvic cases, 288 were male and 184 were female, with a median age of diagnosis of 54. Median tumor size was 96 mm, 64.9% of tumors were considered extracompartmental, and 11.3% of tumors were metastatic at time of diagnosis. The 2, 5, and 10-year survival rates for all cases of primary chondrosarcoma of the pelvis are 76.7%, 61.8%, and 52.2%, respectively. Survival was worse for patients with metastasis, male sex, age >60, tumor size >8 cm, dedifferentiated histology, and no surgical resection. On multivariate assessment high grade and metastasis most significantly predicted worse overall survival. Conclusion: Pelvic chondrosarcoma commonly presents with high-risk features including larger tumor size, extracompartmental extension, and metastatic disease at diagnosis, predicting worse overall survival compared to non-pelvic tumors, and were the least amenable to surgical resection.