Effects of amputation versus limb salvage surgery on the prognosis of primary extremity chondrosarcoma: Evidence from the Surveillance, Epidemiology, and End Results database.

AIM: The demographic and clinical factors influencing the decision between amputation and limb salvage surgery (LSS) in chondrosarcoma patients are compared. METHODS: Data from the Surveillance, Epidemiology, and End Results program were utilized. Individuals ≥ 18-year-old with primary chondrosarcoma located in the limbs and underwent cancer-directed surgery were included. Patients were divided into groups based on receiving LSS or amputation. Factors associated with amputation were determined by logistic regression. Overall survival (OS) and cancer-specific survival (CSS) were assessed by Cox proportional hazard regression analysis. RESULTS: The study included 746 patients (LSS:617; amputation: 129). Compared with patients who underwent LSS, those who underwent amputation had poorer OS (adjusted hazard ratio [aHR]: 1.44, 95% confidence intervals [CI]: 1.08-1.93) and CSS (aHR: 1.60, 95% CI: 1.15-2.21). Lower limb as the primary site (adjusted odds ratio[aOR]: 1.87; 95% CI: 1.21-2.89; p=0.005), and M1 stage (aOR: 2.29; 95% CI:1.31-4.01) were significantly associated with a higher likelihood of undergoing amputation. CONCLUSION: In this population-based real-world study, amputation was associated with poorer OS and CSS among adults with primary extremity chondrosarcoma. This association likely reflects the advanced or surgically complex disease characteristics of patients requiring amputation rather than a direct adverse effect of amputation itself. These findings provide epidemiologic evidence to characterize this high-risk subgroup and inform future risk-stratified studies.