Primary osseous chest wall sarcomas: Oncological and surgical outcomes in a large single-institution cohort of 100 patients

Introduction: Primary osseous chest wall sarcomas are rare tumours with limited evidence guiding surgical management. This study aimed to evaluate oncological outcomes, complication rates, and prognostic factors associated with survival in a large, single-institution cohort. Methods: We retrospectively reviewed 100 patients who underwent chest wall resection for primary osseous sarcoma between 1994 and 2022. Outcomes included overall survival (OS), event-free survival (EFS), local recurrence (LR), distant metastasis (DM), and postoperative complications. The cumulative incidence of LR and DM were estimated using competing risk models. Prognostic factors were analysed with Cox regression. Results: The cohort included 79 patients with chondrosarcoma, eight with osteosarcoma, and 13 with Ewing sarcoma. Negative margins (R0) were achieved in 79%. Reconstruction was performed in 68%, most commonly with mesh. Postoperative complications occurred in 19%. Five-year OS was 79% (70–87%) for the entire cohort, and by subtype: osteosarcoma 38% (4–71%), Ewing sarcoma 67% (41–94%), and chondrosarcoma 85% (77–94%). Recurrence patterns differed, osteosarcoma showed a high 5-year risk of DM (75% (40–100%)), chondrosarcoma predominantly exhibited LR (15% (7–23%)), and Ewing sarcoma both LR (15% (0–36%)) and DM (40% (11–69%)). Notably, grade 1 chondrosarcoma showed metastatic potential, emphasizing that the risk of distant metastasis should also be considered in these low-grade tumours, with a 5-year cumulative incidence of distant metastasis was 11% (95% CI: 0–27%). Tumour size and residual tumour (R1/2) were associated with worse outcomes. Conclusions: Radical resection (R0) remains the most important predictor of survival. 5-year survival differs substantially by subtype (chondrosarcoma 85%, Ewing sarcoma 67% and osteosarcoma 38%), while tumour size is associated with a less favourable prognosis. Individualized reconstructive strategies enable complex resections with acceptable morbidity (19% postoperative complications).