Survival Outcomes and Inflammatory-Nutritional Prognostic Markers in Adult Ewing Sarcoma: A Single-Center Retrospective Cohort
Tolga Doğan1, Atike Gökçen Demiray2, Burcu Yapar Taşköylü2, Arzu Yaren2, Gamze Gököz Doğu21Department of Medical Oncology, Denizli State Hospital, Denizli, Türkiye, 2Department of Medical Oncology, Pamukkale University, Denizli, Türkiye
Objectives: Adult ewing sarcoma is uncommon, and real-world data on survival outcomes and accessible prognostic markers remain limited. This study evaluated survival outcomes and exploratory prognostic factors, with emphasis on lactate dehydrogenase (LDH) and inflammatory-nutritional markers, in an adult single-center Ewing sarcoma cohort. Methods: Adult patients with histologically confirmed Ewing sarcoma who were diagnosed between May 2010 and January 2026 and treated and/or followed at a single medical oncology department were retrospectively reviewed. Follow-up data were updated through May 2026. Overall survival (OS) was calculated from diagnosis to death or last follow-up, and progression-free survival (PFS) was calculated from diagnosis to first progression or death. Survival was estimated using the Kaplan–Meier method. Prognostic associations were assessed using univariable Cox regression and exploratory two-variable Cox models adjusted for metastatic disease. Results: Twenty-three adult patients were included. The median age was 36.4 years, and 9 patients had metastatic disease at diagnosis. During follow-up, 12 deaths and 13 PFS events occurred. Median OS was 78.3 months, with 1-, 2-, and 5-year OS rates of 86.7%, 67.9%, and 52.4%, respectively. Median PFS was 15.9 months, with 1-, 3-, and 5-year PFS rates of 56.5%, 47.8%, and 47.8%, respectively. Metastatic disease was associated with worse OS (HR 6.14, 95% CI 1.74–21.7; p=0.005). Median PFS was not reached in localized disease and was 6.2 months in metastatic disease (log-rank p<0.001). LDH >259 U/L was associated with worse OS in univariable analysis (HR 6.63, 95% CI 1.77–24.9; p=0.005) and remained associated with worse OS after adjustment for metastatic disease (adjusted HR 6.13, 95% CI 1.55–24.2; p=0.010). Platelet- to-lymphocyte ratio (PLR) >169 and systemic inflammation response index (SIRI) >1.74 were associated with worse OS in univariable analysis, whereas a higher prognostic nutritional index (PNI) showed a favorable univariable association and a borderline adjusted association. Conclusion: In this adult Ewing sarcoma cohort, metastatic disease and elevated LDH were associated with inferior survival. LDH was the most consistent laboratory-based prognostic signal after adjustment for metastatic disease. PLR, SIRI, and PNI should be interpreted as exploratory markers requiring validation in larger cohorts. Keywords: Ewing sarcoma, Adult, Survival analysis, Lactate dehydrogenase, Platelet-to-lymphocyte ratio, Prognostic nutritional index
Cite This Article
Doğan T, Gökçen Demiray A, Yapar Taşköylü B, Yaren A, Gököz Doğu G. Survival Outcomes and Inflammatory-Nutritional Prognostic Markers in Adult Ewing Sarcoma: A Single-Center Retrospective Cohort. EJMI. 2026; 10(3): 425-432
Corresponding Author: Tolga Doğan