ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Primary spinal bone sarcomas in Japan: a nationwide comparative analysis of demographic and pathologic features, treatment patterns, and survival.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePrimary spinal bone sarcoma (BS) is a rare malignancy accounting for less than 5% of all bone tumors, and direct comparisons between spinal and non-spinal BS remain limited, particularly in Asian populations. We aimed to compare demographic and pathologic characteristics, treatment patterns, and overall survival (OAS) between primary spinal and non-spinal BS, and to identify prognostic factors within the spinal BS cohort.
methodsIn this retrospective cohort study based on the Japanese National Cancer Registry (NCR), we identified patients with primary BS diagnosed between 2016 and 2019. Spinal and non-spinal BS were compared for demographic and pathologic characteristics, treatment patterns, and OAS using chi-square tests, Kaplan-Meier analysis, and Cox proportional hazards models.
resultsAmong 3,755 patients with BS, 356 (9.5%) had spinal tumors. Compared with non-spinal BS, patients with spinal BS were significantly older (P < 0.001), more frequently presented with advanced disease (P < 0.001), and were less often managed at specialist (Japanese Orthopaedic Association-certified) centers (P = 0.002). Surgery was performed less frequently (33% vs. 68%, P < 0.001) and radiotherapy more often (54% vs. 19%, P < 0.001) in the spinal cohort. The 3-year OAS was significantly poorer in the spinal group (45% vs. 69%, P < 0.001). Within the spinal BS cohort, osteosarcoma was associated with significantly worse OAS than chordoma (hazard ratio [HR] 5.98; 95% confidence interval [CI] 1.71-20.96; P = 0.005), and distant disease at diagnosis predicted worse OAS than localized disease (HR 3.54; 95% CI 1.84-6.81; P < 0.001).
conclusionPrimary spinal BS in Japan differs substantially from non-spinal BS in clinical profile, treatment, and prognosis. Histological subtype and disease extent were the strongest independent prognostic factors. These nationwide real-world data offer a benchmark for risk stratification and may inform future treatment strategies for this rare disease.
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