Epidemiology and Prognosis of Patients With Osteosarcoma at Different Primary Sites: A SEER Population-Based Study.
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BACKGROUND: Osteosarcoma is a primary bone malignancy with a known bimodal age distribution. However, epidemiological patterns based on precise primary anatomical sites are not well characterized. This population-based study analyzed the Surveillance, Epidemiology, and End Results (SEER) database to compare the incidence and clinical features of central-site versus peripheral-site osteosarcoma across different age groups. AIMS: This study aimed to compare the incidence characteristics of peripheral and central-site osteosarcoma (OS) and to explore the impact of different primary sites on the prognosis of patients with OS. METHODS: Patients diagnosed with OS (1975-2019) were selected from the SEER databases. The different primary sites, diagnosis time, and incidence of OS were described statistically. A 1:1 propensity score matching (PSM) was used to adjust for clinical characteristics and treatment. Kaplan-Meier curves were used to compare overall survival and CSS of peripheral and central-site OS before and after matching. Univariate and multivariate Cox models were used to investigate prognostic factors for CSS in both groups. RESULTS: A total of 3129 patients were included (899/28.73% central-site OS, 2166/69.22% peripheral-site OS, 64/2.05% other-site OS). After PSM, central-site OS had lower overall survival and CSS than peripheral-site OS (5-year overall survival, 0.415 vs. 0.468; 5-year CSS, 0.454 vs. 0.555). Multivariate analysis revealed that age (p = 0.010), primary site (p = 0.039), historical SEER stage (regional, p = 0.012; distant, p < 0.001), histologic grade (grade III, p = 0.014; grade IV, p = 0.009), surgery (p < 0.001), and radiotherapy (p = 0.005) were significant factors for CSS. Subgroup analyses adjusting for these factors showed better CSS in peripheral-site OS patients. CONCLUSIONS: The incidence of central-site OS is lower than that of peripheral-site OS, while the prognosis of patients with peripheral-site OS is more favorable than that of patients with central-site OS. Surgical intervention is a cornerstone in the management of OS and is effective for both central-site and peripheral-site OS.