Incidence figures prognostic factors and survival
Incidence figures, prognostic factors and survival rates for chondrosarcoma, osteosarcoma and Ewing sarcoma have been defined based on a large series [, , , , , , , , ]. These series are based on cohorts from several hospitals in various countries and regions, with different treatment regimens. Several single-institution cohorts have also been described in the Netherlands [16,17]. Importantly, diagnosis and treatment of bone sarcomas have become increasingly centralised in four cooperating bone tumour centres in the past two decades in order to optimise treatment strategies and survival.
To evaluate the impact of centralised bone sarcoma care on a national level, more recent population-based incidence estimates and information on treatment and survival patterns may prove invaluable. The Netherlands is a relatively small and economically developed country with a steady population without significant Methylpiperidino pyrazole in our study period.  Furthermore, high-quality databases are available to allow a comprehensive assessment. Information on histological material after a biopsy or resection of a bone sarcoma is centrally stored in the database of the Dutch Pathology Network (PALGA), and clinical information obtained after histological confirmation is collected in the Netherlands Cancer Registry (NCR).
Patients and methods
Discussion For high-grade chondrosarcoma, the incidence rate of 0.15 per 100,000 persons (n = 429) in our study was comparable with the incidence described in literature. Dorfman et al. displayed an incidence of 0.2 per 100,000 persons (n = 677) between 1973–1987 in the United States . Whelan et al. displayed an incidence of 1.7 towards 2.0 per 1 million persons between 1979–2007 in England, Stiller et al. displayed an incidence of 0.2 per 100,000 persons (n = 1965) between 1995–2002 in Europe [19,20]. The incidence of chondrosarcoma in Taiwan was lower with 1.2 per million persons (n = 244) between 2003–2010 . The incidence rate of 0.25 per 100,000 persons (n = 605) for central high-grade osteosarcoma in our study was also comparable with literature. Mirabello et al. display an incidence rate of 3.1 per million persons (n = 2336) for all osteosarcoma subtypes in the United States between 1973−2004.  Duong et al. found an incidence rate of 2.71 per million persons (n = 7.104) for malignant primary osteosarcoma in the United States between 1999 and 2008 . Dorfman et al. displayed an incidence rate for osteosarcoma of 0.3 per 100,000 persons (n = 922) between 1973–1987 in the United States . An interesting finding in our study population is the absence of a second age peak for osteosarcoma. Based on the available literature, the second age peak for osteosarcoma is most common in the United Kingdom, Australia and Canada followed by Europe and the United States . For Latin America and Asia the available literature is limited, although Hung et al. published incidences for osteosarcoma showing a small second age peak [21,22]. For Ewing sarcoma patients the incidence rate of 0.15 per 100,000 persons (n = 334) in our publication concurs with existing data. Dorfman et al. display an incidence rate for Ewing sarcoma of 0.1 per 100,000 persons (n = 420) . Similar incidences of 0.1 per 100,000 persons were reported by Stiller et al. (n = 1046) . A slightly lower incidence for Ewing sarcoma was seen in Taiwan with 0.89 per million persons . Survival analysis in our study population shows that the 5-year overall survival rates for high-grade chondrosarcoma (65.9%), high-grade central osteosarcoma (53.9%) and Ewing sarcoma (59.3%) are comparable with existing large series [, , , ]. Hung et al displayed a 5-year overall survival rate of 72.6% for high-grade osteosarcoma between 2004 and 2011 in Taiwan (n = 125) . As identified earlier in several publications and concordant with our study, metastasis at diagnosis proved to be a prognostic factor for high-grade chondrosarcoma, high-grade central osteosarcoma and Ewing sarcoma [7,8,12,23,24,, , ].