Osteosarcoma: A Surveillance, Epidemiology, and End Results program-based analysis from 1975 to 2017

Abstract

Background: Osteosarcoma is the most common primary bone malignancy. As a rare cancer, population-based studies remain small with limited information on finer demographic categories. Recent studies have reported important genetic differences based on age and ethnicity, and more detailed studies are needed to better understand potentially important osteosarcoma risk groups.

Methods: Incidence and survival rates for 5016 patients with osteosarcoma from the Surveillance, Epidemiology, and End Results (SEER) program (1975-2017) were analyzed by age (0-9, 10-24, 25-59, and >60 years old), race/ethnicity, histologic subtype, stage, and tumor location using SEER*Stat software.

Results: For cases 0 to 9 years old, incidence of primary osteosarcoma was similar between the sexes, increased significantly throughout the study period (P < .05), and the 5-year relative survival has steadily increased over time. Blacks had the highest incidence in all aged cases combined and a significant increase in incidence throughout the study period (P < .05). Overall, survival rates for all cases have remained relatively unchanged over recent decades, with worse survival observed in males, American Indian/Alaska Native cases, older patients, metastatic disease, axial tumors, and subsequent osteosarcoma cases. For cases 0 to 24 years old, the incidence of subsequent osteosarcoma increased 3-fold since the 2000s.

Conclusion: Important differences in osteosarcoma incidence and survival, particularly for the youngest children, ethnic minorities, and subsequent osteosarcoma, are identified. A genetic risk factor may be associated with observed ancestry-specific incidence differences and illustrates the importance of analyzing osteosarcoma by specific age groups and ethnicities to better understand their unique epidemiology and underlying biology.

Lay summary: Osteosarcoma is the most common bone cancer, but still a relatively rare disease, and previous studies have had limited information on finer demographics. Using a large database, osteosarcoma incidence and survival patterns are thoroughly evaluated and important differences, especially for the youngest children, ethnic minorities, and subsequent osteosarcoma cases, are identified.

Keywords: SEER; epidemiology; incidence; osteosarcoma.

Figure 1.

Incidence of osteosarcoma based on the Surveillance, Epidemiology, and End Results 18 database, 2000 to 2017. Incidence rates are age-adjusted calculated using the 2000 US standard population.

Figure 2.

Incidence of osteosarcoma based on the Surveillance, Epidemiology, and End Results (SEER) 9 database, 1975 to 2017, by age group and year of diagnosis. Incidence rates are age-adjusted calculated using the 2000 US standard population. Number of total years per decade group varies based on available years in the SEER database.

Figure 3.

Five-year relative survival of primary osteosarcoma by decade, based on the Surveillance, Epidemiology, and End Results (SEER) 9 database, 1975 to 2016. Five-year relative survival rates within each age group were compared by decade with 2010 to 2016 as the comparison group. Significantly different survival rates (P < .05) using the Z test are marked with (*). Number of total years per decade group varies based on available years in the SEER database.

Figure 4.

Five-year relative survival of metastatic osteosarcoma by decade, based on the Surveillance, Epidemiology, and End Results (SEER) 9 database, 1975 to 2015. Five-year relative survival rates within each age group were compared by decade with 2010 to 2015 as the comparison group. Significantly different survival rates (P < .05) using the Z test are marked with (*). The 0- to 9-year-old and 10- to 24-year-old age groups were combined to have sufficient number of cases for analysis. Number of total years per decade group varies based on available years in the SEER database. The 25- to 59-year-old age group (B), 1975 to 1979 decade is based on only 9 cases.