{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,8]],"date-time":"2025-11-08T23:04:26Z","timestamp":1762643066943,"version":"3.41.2"},"reference-count":31,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T00:00:00Z","timestamp":1723507200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Children \u22645\u00a0years of age with Ewing's sarcoma (ES) possibly have a distinct disease biology, data on which are scarce. We evaluated clinical features, outcomes, and prognostic factors of ES among children with age \u22645\u00a0years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children with ES registered between 2003 and 2019 were included. Baseline clinical and treatment details were retrieved from medical records. Prognostic factors were identified using multivariable Cox regression. Clinical features and outcomes of children \u22645\u00a0years were compared with those greater than 5\u00a0years by chi\u2010square and log\u2010rank tests. Propensity score\u2010matched (PSM) analysis was done to evaluate the impact of age on survival in the metastatic and localized subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Out of the 859 patients, 86 (10%) were \u22645\u00a0years of age (median age 4\u00a0years, 60 males [69.8%]). The most common location was the extremities (37.2%), followed by thorax (27.9%) and head and neck (H&amp;N) (22.1%); baseline metastases were seen in 25 patients (29.8%). The median event\u2010free\u2010survival (EFS) and overall survival (OS) were 25.6 and 68.7\u00a0months, respectively. Metastatic disease predicted inferior OS (hazard ratio [HR]\u00a0=\u00a02.54, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.018) and EFS (HR\u00a0=\u00a02.47, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.007], symptom duration \u22643\u00a0months predicted an inferior OS (HR\u00a0=\u00a02.17, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.048). Compared to age greater than 5\u00a0years, younger children had more H&amp;N and less pelvic primaries (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and lesser baseline metastases (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.037). PSM analysis did not reveal any significant impact of age on OS in the metastatic (HR\u00a0=\u00a01.59, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.29) or localized cohort (HR\u00a0=\u00a01.77, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.09).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Children with ES \u22645\u00a0years of age have a distinct favorable clinical presentation. However, age is not an independent prognostic factor for survival outcomes when adjusted for confounders.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.31268","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T04:15:04Z","timestamp":1723608904000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ewing sarcoma among children 5\u00a0years of age or younger: Is it a different disease?"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-2446","authenticated-orcid":false,"given":"Chitrakshi","family":"Nagpal","sequence":"first","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. IRCH All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7296-6088","authenticated-orcid":false,"given":"Shuvadeep","family":"Ganguly","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Jawaharlal Institute of Post Graduate Medical Education and Research  Puducherry India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archana","family":"Sasi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. IRCH All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivek","family":"Kumar","sequence":"additional","affiliation":[{"name":"Division of Neonatology Department of Paediatrics All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bivas","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Apollo Multispecialty Hospital  Kolkata India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-331X","authenticated-orcid":false,"given":"Deepam","family":"Pushpam","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. IRCH All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akash","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology National Cancer Institute All India Institute of Medical Sciences  Jhajjar India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8315-5814","authenticated-orcid":false,"given":"Sandeep","family":"Agarwala","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9273-097X","authenticated-orcid":false,"given":"Vishesh","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2050-7872","authenticated-orcid":false,"given":"Anjan","family":"Dhua","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3158-1322","authenticated-orcid":false,"given":"Devender Kumar","family":"Yadav","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shah Alam","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adarsh","family":"Barwad","sequence":"additional","affiliation":[{"name":"Department of Pathology All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asit Ranjan","family":"Mirdha","sequence":"additional","affiliation":[{"name":"Department of Pathology All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3453-5340","authenticated-orcid":false,"given":"Ahitagni","family":"Biswas","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Dr. B.R.A. IRCH All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"Thulkar","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis Dr. B.R.A. IRCH All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9367-4407","authenticated-orcid":false,"given":"Sameer","family":"Bakhshi","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.R.A. IRCH All India Institute of Medical Sciences  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,8,13]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Cancer incidence and survival among children and adolescents\u2014pediatric monograph\u2014SEER publications 1975\u20131995.SEER. Accessed November 26 2023.https:\/\/seer.cancer.gov\/archive\/publications\/childhood\/index.html"},{"issue":"2","key":"e_1_2_10_3_1","first-page":"927","article-title":"Development and validation of a prognostic score at baseline diagnosis for Ewing sarcoma family of tumors: a retrospective single institution analysis of 860 patients","volume":"14","author":"Sasi A","year":"2022","journal-title":"Am J Transl Res"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2000.18.17.3108"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25635"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0053223"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.27251"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1054\/bjoc.2001.2150"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22821"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/927123"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.22.9864"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2014.05.006"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.6001\/actamedica.v24i4.3615"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2012.08.006"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.3.281"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.41.5703"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa020890"},{"key":"e_1_2_10_18_1","unstructured":"TherneauTM.A package for survival analysis in R. R package version 3.7\u20100.R\u2010Project;2023. Accessed October 14 2023.https:\/\/cran.r\u2010project.org\/web\/packages\/survival\/index.html"},{"key":"e_1_2_10_19_1","unstructured":"KassambaraA KosinskiM BiecekP FabianS.survminer: drawing survival curves using \u201cggplot2.\u201dR\u2010Project; March 9 2021. Accessed October 14 2023.https:\/\/cran.r\u2010project.org\/web\/packages\/survminer\/index.html"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v042.i08"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.24552"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24985"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22615"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(22)00688\u2010X"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2013.31.15_suppl.e21522"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.00411"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.30135"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2019.01.008"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.24045"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.23861"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10163627"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/pin.13293"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.31268","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T13:52:10Z","timestamp":1748353930000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.31268"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,13]]},"references-count":31,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1002\/pbc.31268"],"URL":"https:\/\/doi.org\/10.1002\/pbc.31268","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"type":"print","value":"1545-5009"},{"type":"electronic","value":"1545-5017"}],"subject":[],"published":{"date-parts":[[2024,8,13]]},"assertion":[{"value":"2023-11-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-07-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e31268"}}