Prognostic factors influencing overall and cancer-specific survival in Ewing sarcoma: an analysis of 4242 cases from the SEER database

Introduction: Ewing sarcoma is a rare, aggressive malignancy primarily affecting children and young adults, characterized by significant clinical variability and complex prognostic factors. Methods: In this study, we analyzed data from 4242 patients with Ewing sarcoma from the Surveillance, Epidemiology, and End Results (SEER) database to identify sociodemographic and clinical factors influencing overall and cancer-specific survival. We evaluated the impact of age, tumor location, disease stage, and treatment modalities, including surgery, chemotherapy, and radiotherapy, on survival outcomes. Results: The mean age of the patient sample was 21.54 ± 14.82 years. A total of 2530 (59.6%) patients were male. The most common tumor location was bone (3106, 73.2%), followed by soft tissue (843, 19.9%). In multivariate analysis, tumor location in the retroperitoneum and peritoneum (aHR: 1.655, 95% CI: 0.9604 to 2.640), age (aHR: 1.031, 95% CI: 1.026 to 1.037), distant disease (aHR: 3.337, 95% CI: 2.694 to 4.161), and regional disease (aHR: 1.363, 95% CI: 1.077 to 1.729) were independent predictors of poor cancer-specific survival. Subgroup analyses reveal distinct survival patterns across osseous, soft tissue, and retroperitoneal Ewing sarcoma cases, underscoring the importance of site-specific treatment approaches. Discussion: This study provides valuable insights into the prognostic landscape of Ewing sarcoma, informing both clinical practice and future research focused on enhancing survival outcomes for this challenging malignancy.