Survival and Functional Outcomes in Surgically Treated Pelvic Chondrosarcoma: A Retrospective Single-Center Cohort Study

Abstract Background Pelvic chondrosarcoma is a rare malignant bone tumor associated with challenging surgical management, high morbidity, and variable oncological outcomes. The rarity of pelvic chondrosarcoma has limited the availability of robust data on prognostic factors and functional outcomes. This study evaluated survival, prognostic factors, complications, and functional outcomes following surgical treatment of primary and recurrent pelvic chondrosarcoma. Methods We retrospectively analyzed 54 consecutive patients who underwent surgery for primary pelvic chondrosarcoma (n = 37) or recurrent local disease (n = 17) at a single tertiary musculoskeletal oncology center between 1990 and 2024. Patients undergoing surgery for metastatic pelvic lesions were excluded. Overall survival was estimated using the Kaplan–Meier method and compared using log-rank tests. Univariable and exploratory multivariable Cox proportional hazards regression analyses were performed to identify prognostic factors. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score. Results The mean follow-up was 31.7 months. During follow-up, 22 patients died. Estimated overall survival was 87.0% at 1 year, 63.2% at 3 years, and 52.7% at 5 years. Increasing age was independently associated with poorer overall survival (adjusted hazard ratio [HR] per year, 1.06; 95% confidence interval [CI], 1.02–1.10; p = 0.001), whereas tumor grade and recurrent disease at study inclusion were not independently associated with mortality. Functional outcome was available for 27 patients, with a mean MSTS score of 11.6 ± 5.8. Revision surgery was required in 70.4% (n = 38) of patients. Conclusions Surgical treatment of pelvic chondrosarcoma is associated with considerable morbidity and limited functional outcome. In this cohort of patients with primary and recurrent pelvic chondrosarcoma, increasing age was the only independent prognostic factor for overall survival. These findings provide clinically relevant information for patient counseling and surgical decision-making but should be interpreted in light of the retrospective design and limited cohort size.