Clinical predictors of overall survival in very elderly patients with spinal osteosarcoma: an analysis of the surveillance, epidemiology, and end results database

Neurochirurgie. 2026 Jun 30:101843. doi: 10.1016/j.neuchi.2026.101843. Online ahead of print.

ABSTRACT

INTRODUCTION: Spinal osteosarcomas are a rare pathology affecting the spine, with treatment of osteosarcoma remaining controversial. Despite the significant body of literature, little has been assessed regarding survival, outcomes, and surgical resection for very elderly patients.

METHODS: A retrospective analysis of 218 patients from the SEER database was conducted using Kaplan-Meier survival curves and Cox proportional-hazards models. Patients were stratified into 65-74 and 75+ years cohorts. Multivariable analyses were performed to identify survival predictors in each group with subgroup analysis conducted adjusting for tumor grade of 85 patients.

RESULTS: Patients aged 75+ were less likely to undergo surgery (p = 0.031) or chemotherapy (p = 0.001). In multivariable analysis, gross total resection (GTR) was associated with improved survival in both 65-74 (HR: 0.429, p = 0.047) and ≥75 cohorts (HR: 0.563, p = 0.009), while subtotal resection (STR) conferred survival benefit only in the ≥75 group (HR: 0.499, p = 0.019). Chemotherapy improved survival in only the 65-74 cohort (HR: 0.567, p = 0.034). With the model adjusted for tumor grade, GTR remained protective in the younger elderly (HR: 0.174, p = 0.010) though chemotherapy became insignificant. In the ≥75 cohort, STR (HR: 0.062, p < 0.001) and GTR (HR: 0.069, p < 0.001) retained strong associations with improved survival.

CONCLUSION: Both STR and GTR improve overall survival in patients ≥75 years of age, with persisting benefits after adjustment for tumor grade. Chemotherapy and radiotherapy demonstrated additional survival advantages in the very elderly when grade was considered. These findings highlight treatment feasibility and multimodal therapy as more critical than histologic grade in guiding decisions.

PMID:42373342 | DOI:10.1016/j.neuchi.2026.101843