Objective: To evaluate age-related prognostic differences in Ewing sarcoma (ES) patients and identify clinical factors influencing outcomes in a tertiary care setting.
Materials and
Methods: Seventy-six patients with ES (ages 1–78) treated between 2010 and 2024 were reviewed retrospectively. Clinical features and treatments were compared across four age groups (0–9, 10–17, 18–25, and ≥25 years). Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier curves and compared with log-rank tests.

Results: There were no statistically significant differences in 10-year OS or DFS between age groups (p>0.05), although patients ≥18 years showed a trend toward worse survival. The presence of metastases at diagnosis was associated with markedly lower survival (5-year OS 20–30% vs. 70% for localized disease). Patients who underwent surgical resection of the primary tumor had significantly better survival than those managed without surgery, while limb-salvage versus amputation showed no difference in outcomes. Relapse was associated with poor prognosis.

Conclusion: Adult ES patients tend to have poorer outcomes than children, though age alone was not a significant predictor in this series. Achieving effective local control with surgery and addressing metastatic disease remain critical to improving survival.