The Role of Sociodemographics in Pediatric, Adolescent and Young Adult Osteosarcoma: A Population Based Study

Background: In our population-based study, we examine the impact of patient demographics on disease presentation, treatment and survival for children, adolescents, and young adults with osteosarcoma. Methods: Patient data was downloaded from The Surveillance, Epidemiology, and End Results database. Cases included patients ages 0–24 years who were diagnosed with osteosarcoma between 2004 and 2020. We used multivariable logistic regression to determine associations between patient sociodemographics, disease presentation, and treatment. Disease-specific survival was assessed using multivariable Cox regression to estimate hazard ratios. Results: 2364 patients were included. When compared to non-Hispanic White patients, Hispanic patients were more likely to have metastases (OR = 1.56, p < 0.01), tumors ≥8 cm (OR = 1.37, p < 0.01), and undergo amputation (OR = 1.54, p < 0.01). Asian patients were more likely to have tumors ≥8 cm (OR = 1.92, p < 0.01), and receive chemotherapy (OR = 4.92, p < 0.01). Black patients were more likely to have ≥1 month elapse between diagnosis and treatment (OR = 1.36, p = 0.03). Differences in survival across race/ethnicity were not significant when accounting for primary site and metastases at presentation. Male patients presented with more advanced disease, were more likely to undergo amputation, and had lower survival. Patients in adolescent (11–18 years) and young adult (19–24 years) age groups were more likely to present with axial/pelvic tumors, experience lapses between diagnosis and treatment, and had lower survival rates than younger patients. Conclusions: Observed differences are likely due to a combination of socioeconomic and biological factors. Future work should focus on examining variations in genetic drivers of osteosarcoma progression and barriers to care across patient populations. Type of study: Retrospective Cohort Study. Level of evidence: IV.