- Open Access
Bibliometric analysis of Ewing sarcoma from 1993 to 2022
BMC Cancer volume 23, Article number: 272 (2023)
Ewing sarcoma has attracted more attention in recent years but has yet to be bibliometrically analyzed. Hence, this study investigated the trend of Ewing sarcoma over the past 30 years with bibliometric analysis.
Original publications related to Ewing sarcoma were obtained from the Science Citation Index Extension (SCI-E), Social Sciences Citation Index (SSCI), and Web of Science Core Collection (WoSCC) between 1993 and 2022. CiteSpace and VOSviewer were used to extract the countries/regions, institutions, authors, journals, references, and keywords involved in this topic to identify and analyze the research hotspots and trends in this field.
Over the past 30 years (especially in the past five years), the number of articles published on Ewing sarcoma continued to increase, and the most published country was the United States of America (USA). High-frequency keywords included "Ewing sarcoma", "tumor", "family", "bone", "chemotherapy", "expression", "primitive neuroectodermal tumor", "prognostic factors", "children", and "survival rate". According to the analysis of keyword saliency of Ewing sarcoma, we found that "chromosome translocation", "intergroup", "sarcoma", "genomic landscape", and "children oncology group" were emerging research hotspots. The timeline of the cluster map of co-cited literature indicated that the treatment of Ewing sarcoma emerged as a research hotspot.
Researchers' understanding of Ewing sarcoma has improved dramatically over the past 30 years. At present, the research hotspots of Ewing sarcoma mainly focus on the aspects of "chromosome translocation", "intergroup", and "sarcoma". In addition, the timeline of the cluster map of co-cited literature indicated the emergence of the treatment of Ewing sarcoma as a research hotspot.
Ewing sarcoma ranks second among orthopedic malignant tumors, behind osteosarcoma . It is common in adolescents, and the incidence rate accounts for 10 to 15% of orthopedic tumors . The peak incidence occurs at the age of 15, and the incidence rate in males is higher than in females, with a ratio of 3:2 . Although Ewing sarcoma accounts for only 1% of human malignant tumors, it is extremely aggressive and can rapidly metastasize to the lung and other tissues. The five-year overall survival rate of patients with both Ewing sarcoma and a localized disease is between 65 and 75% . The common symptom of Ewing sarcoma is intermittent pain in children and adolescents, which may complicate and delay the diagnosis process and is often neglected. The survival rate of patients is approximately 70% after five years and decreases sharply to 30% after 10 years. Tumor metastasis at the time of diagnosis further reduces the survival rate after five years to only 25% . The poor survival rate of Ewing sarcoma has since gained awareness.
Bibliometric analysis is a method of using mathematical and statistical techniques to analyze books, articles, and other literature for a general understanding of a new field. It is also a tool to explore the structure and trends of a topic through visualization and statistics for a quantitative assessment of the impact of research literature on selected research areas, countries/regions, research collaborations, journals, institutions, and authors in a given period [5, 6]. Compared with traditional systematic reviews and meta-analyses, bibliometric analysis can reveal key issues and developments in the field of interest more systematically and intuitively, thereby guiding future research . CiteSpace is a visual analysis software that studies the structure, patterns, and distribution of research areas . VOSviewer software is effectively used for knowledge domain mapping . VOSviewer and CiteSpace can directly reflect the development of the research field by providing a large amount of data, including the productivity of authors and institutions, geographical distribution by region, and the results of collaborative relationships, and they are widely used in a variety of application areas [8, 9].
Bibliometrics and visualization methods have been used for osteosarcoma, osteoarthritis, osteonecrosis of the femoral head, and other orthopedic diseases. However, a review of Ewing sarcoma using bibliometrics and visualization methods has not been published to investigate the longitudinal and transverse characteristics of Ewing sarcoma, trends, and its multiple branches. Hence, this study explored the major contributors to the field over the past two decades and identified the hotspots and research trends in various aspects. The results of this study provided new insights on Ewing sarcoma to global research teams and orthopedic specialists.
Materials and methods
Data collection and search strategy
In this study, bibliometric analysis was performed using the Science Citation Index Extended Edition and the Social Sciences Citation Index of the WoSCC database. The search phrase was: Title = (Ewing sarcoma* OR Ewing’s sarcoma* OR Ewing tumor* OR Ewing’s tumor*). The language of the document was limited to English. Relevant publications between 1993 and 2022 were searched from the database, and only original articles and reviews were included in our analysis. Conference abstracts, editorial material, correspondence, and book chapters were excluded. The detailed flow chart of the article selection process in this study is displayed in Fig. 1. To avoid bias from database updates, all publication searches and file downloads were conducted on September 21, 2022. Two researchers in the study independently examined data collection and input. The differences in the results obtained by the two researchers were resolved through discussion or consultation with experts in the field to reach a consensus.
Data was converted into text documents before uploading into the bibliometric analysis software. CiteSpace 6.1 R3, 64-bit (Drexel University, Philadelphia, PA, USA), VOSviewer 1.6.11(Leiden University, the Netherlands), and the Bibliometrics Online Analysis platform (http://bibliometric.com/) were used to locate the network characteristics of co-cited references, keywords, countries, institutions, authors, journals and "keyword burst" and visually present the results. The 2022 journal citations report was analyzed, including its impact factor category quartiles, and category ranking.
VOSviewer can be used to construct "scientific knowledge networks" that map the evolution of research fields and institutional collaborations and predict future research hotspots. In this work, VOSviewer was used to visually estimate word co-occurrence and construct density maps. The co-occurrence analysis function in VOSviewer can be used to classify keywords into different categories, which are represented by different colors. Cluster analysis of research hotspots can be visualized, and the keyword co-occurrence network can predict the growth trend.
A series of publication analyses were performed using CiteSpace to identify research hotspots for Ewing sarcoma. The analysis included publications, co-cited references, and relevant keywords. In the constructed network visualization, nodes reflect observed items, with larger nodes representing items that occur more frequently. In addition, CiteSpace was used to analyze centrality, a metric that defines the importance of network nodes, where more prominent nodes represent higher centrality. Centrality is used to measure the importance of a node's position in a network. The higher the centrality, the more connections in the network that pass through that node.
Overview of publications
From 1993 to 2022, a total of 3016 original articles on Ewing sarcoma were published. Over the past 30 years, there has been an overall increase in the number of studies related to Ewing sarcoma (Fig. 2). At the same time, the magazines publishing about Ewing sarcoma also demonstrated a growing trend, with the highest increment recorded between 2015 and 2021. Ewing sarcoma-related articles were published the most in 2021, accounting for about 7% of all original articles on Ewing sarcoma (Fig. 3).
Distribution of countries/regions and institutions
Figure 4 illustrates the national collaboration network for Ewing sarcoma research. All the data were analyzed in CiteSpace, and the results are displayed in Table 1. The USA had the largest number of Ewing sarcoma-related articles, with 1082 articles, followed by Germany with 298 articles, Italy with 252 articles, China with 249 articles, Japan with 220 articles, Spain with 181 articles, France with 167 articles, India with 155 articles, England with 150 articles, and Austria with 122 articles. The USA accounted for about 35.9% of articles (Table 1). Centrality is an index that defines the importance of network nodes, where more prominent nodes represent higher centrality. In the study of Ewing sarcoma, the USA had the highest centrality (0.39), followed by Germany (0.18) and England (0.17) (Table 1). In cooperative networks, higher centrality represents closer cooperation. The country-based research network map displayed a lower density, indicating the relative independence of the research teams and the need for further collaboration.
Similarly, the top five institutional cooperation included NCI (73), Mem Sloan Kettering Canc Ctr (70), Univ Texas MD Anderson Canc Ctr (70), Ist Ortoped Rizzoli (66), and Ist Curie (49) (Table 2). Among these, NCI centrality was the highest at 0.31, followed by Mem Sloan Kettering Canc Ctr (0.20) and Univ Texas MD Anderson Canc Ctr (0.11) (Fig. 5; Table 2). The low centrality of all institutions indicated low inter-agency cooperation.
Author network analysis
VOSviewer analysis of the authors of published Ewing sarcoma articles revealed that Juergens Heribert published the most articles (84), followed by Picci Piero (83), Dirksen Uta (76), and Scotland Katia (66). Similarly, the number of citations per article is a measure of the quality of the article. Paulussen Michael ranked first with approximately 95.05 citations per article, followed by Juergens Heribert with 55.35 citations per article, and Kovar Heinrich with about 54.68 citations per article (Table 3). The distribution of collaboration revealed the dispersed relationship between these authors, indicating poor collaboration between academics (Fig. 6).
Analysis of the number of publications
Pediatric Blood & Cancer had the largest number of publications (128), followed by the Journal of Pediatric Hematology Oncology (77) and Cancer research (68). In terms of the average number of citations, the Journal of Clinical Oncology had the largest average number of citations (129.69), followed by Cancer Research (77.97) and Oncogene (59.04). Most of the top 10 journals were in JCR Q1 (Table 4).
Ewing sarcoma research has received support from a variety of funding agencies. The top three funding agencies were the USA Department of Health & Human Services, the National Institutes Of Health (NIH) USA, and the National Cancer Institute (NCI) (Table 5).
Keywords co-occurrence analysis
Through VOSviewer, keyword co-occurrence analysis was performed for Ewing sarcoma articles. Keyword co-occurrence analysis refers to the frequency of two keywords appearing in the same article. Similarly, the size of the circles and the thickness of the lines represent the frequency of keyword occurrences and co-occurrences. These keywords were searched in 3016 articles. When the frequency of occurrence was screened to 20, only 226 articles met the conditions. The frequency in the top 10 included “Ewing sarcoma” (n = 1789), “tumor” (n = 904), "family" (n = 602), "bone" (n = 580), "chemotherapy" (n = 453), "express" (n = 425), "primitive neuroectodermal tumor" (n = 365), "prognostic factors" (n = 286), "children" (n = 262), and "survival rate" (n = 253) (Fig. 7A). According to the clustering of keyword co-occurrence, the keywords were divided into four groups: Ewing sarcoma gene expression group (red color), Ewing sarcoma diagnosis group (blue color), Ewing sarcoma prognosis group (green color), and Ewing sarcoma treatment group (yellow color) (Fig. 7A). The keywords were measured by the depth of the color of the area. Research work was focused on the diagnosis of Ewing sarcoma before 2010 (dark color), followed by the prognosis and gene expression of Ewing sarcoma from 2010 to 2014 (intermediate color), and the treatment of Ewing sarcoma after 2014 (light color) (Fig. 7B). Meanwhile, the density of the keywords was measured by the color intensity in VOSviewer. The hotspot of this research was often in the red area (Fig. 7C).
Keywords emergent analysis
CiteSpace was used to analyze the emergence of keywords in Ewing sarcoma. The blue line represented the total timespan, and the red line marked the outbreak period to indicate the start and end of the outbreak. From 1993 to 2010, the outbreak intensity of chromosome translocation was the largest (n = 24.3). From 2010 to 2016, the outbreak intensity of the children's oncology group was the largest (n = 20.88). After 2016, the outbreak intensity of the genomic landscape was the largest (n = 22.45) (Fig. 7D).
Analysis of the most commonly co-cited articles
The top 10 co-cited articles on Ewing sarcoma are listed in Table 6, with citations ranging from 206 to 485. Delattre O had the highest number of co-citations (n = 485), followed by Grier HE and Cotterill SJ with 405 and 400 co-citations, respectively. Most of the articles were published before 2010, and the co-cited articles were all in the Q1 of JCR (Table 6).
Analysis of co-cited reference
The analysis of citations is considered an important part of bibliometrics research. Figure 8A illustrates the visual network of co-cited references, consisting of 433 nodes and 2198 links. Each node represents a cited article, and links between nodes indicate the frequency of the same citations. The diameter of a node is proportional to the frequency with which references were cited. The frequency of references to the same article is represented by links between nodes. The node diameter is proportional to the total number of articles co-cited. The developmental stages of a domain can be connected by nodes, where centrality is indicated by a thick purple ring.
The references were divided into 10 groups: Ewing sarcoma, MSC, childhood cancer, apoptosis, trabectedin, targeted therapy, EWS gene, predictive factor, radiation therapy, and Ewing-like sarcoma. After collating the cited literature into a sequence diagram, the treatment of Ewing sarcoma became a hotspot (Fig. 8B and C). Most of the articles were published in JCR Q1 journals, indicating the importance of Ewing sarcoma research (Fig. 8D).
Distribution of links between journals
The distribution of links between journals was displayed in a dual map overlay of journals, with the citing journals on the left and the cited journals on the right. The described relationships were represented by colored routes connecting them. These labels represented the topics covered by the journals. The primary reference paths were labeled as two green paths and one orange path. The green path illustrated studies published in Molecular/Biology/Genetics and Health/Nursing/Medicine journals that were cited by Medicine/Medical/Clinical journals. The orange route illustrated studies published in Molecular/Biology/Genetics journals that were cited by Molecular/Biology/Immunology journals (Fig. 9).
Ewing sarcoma is the second most common osteosarcoma in children. The most common sites for Ewing sarcoma metastasis are the lungs and bone marrow . The five-year survival rate for patients with localized disease is 60 to 70% as compared with 20 to 45% of patients with metastatic disease . However, the prognosis of Ewing sarcoma has improved over the past decades with the use of multimodal treatment including chemotherapy, surgery, and radiotherapy . However, a large proportion of patients with Ewing sarcoma did not report improved treatment outcomes. Therefore, it is necessary to understand Ewing sarcoma by analyzing past research data. This study reported for the first time the quantitative and qualitative bibliometric analysis of Ewing sarcoma research, covering 3016 research articles from WoSCC. The results revealed that the total number of Ewing sarcoma-related research papers published annually worldwide has gradually increased over the past three decades, reflecting its growing importance in the field of orthopedics.
Of the 3016 articles, the USA contributed 35.9% of the research articles, demonstrating the strong collaboration and highest centrality with other countries. This was followed by Germany, Italy, and China, with lesser cooperation and relatively low centrality. These countries should strengthen international cooperation, especially with leading countries in Ewing sarcoma research. In addition, more than half of the top 10 research institutions are located in the United States, which promotes the progress and development of Ewing sarcoma research. This trend reflects the advancement of Western medical research and the urgency for an effective Ewing sarcoma treatment. NCI, Mem Sloan Kettering Canc Ctr, Inst Curie, and Univ Texas MD Anderson Canc Ctr have the strongest partnerships with other institutions. In terms of fund sponsorship, most of the top 10 fund-sponsoring countries are in Europe and the USA, indicating the high investment in Ewing sarcoma research. China and Japan were also in the top 10 countries sponsored by the fund, indicating the promising research of Ewing sarcoma in Asia.
Juergens Heribert has published the most articles on Ewing sarcoma with 94 articles, followed by Picci Piero (83), Dirksen Uta (76), and Scotland Katia (66). These researchers are mainly situated in Europe and the USA and had worked in orthopedic or oncology departments at their university hospitals. Therefore, strengthening the communication and cooperation among researchers around the world will help the development of Ewing sarcoma research.
The most published journals of Ewing sarcoma are the top journals in the oncology field, including Cancer Research, Clinical Cancer Research, and Journal of Clinical Oncology. The publication of these journal articles on Ewing sarcoma demonstrated that Ewing sarcoma remains a major issue for orthopedic and oncology research. From 1993 to 2002, the top 10 co-cited literature proved that Ewing sarcoma research focused mainly on its treatment.
For keyword co-occurrence, the top 10 keywords were closely related to the age of epidemiology, prognosis, and treatment of Ewing sarcoma. Emergent keywords indicated emerging trends and research frontiers. Through keyword hotspot analysis, the keyword hotspots of Ewing sarcoma focused on chromosome translocation, children's oncology group, and genomic landscape. Delattre O demonstrated that the pathogenesis of Ewing sarcoma is related to the t(11; 22) (q24; q12) chromosomal translocation . It was later reported that Ewing sarcoma has more chromosomal translocations, including EWS/FLI fusion, EWS/ERG fusion, EWS/FEV fusion, EWS/ETV1 fusion, EWS/ETV4 fusion, FUS/ERG fusion, FUS/FEV fusion, and FUS/ETV4 fusion . The children's oncology group is an international research organization dedicated to developing new treatments and cures for cancer in infants, children, adolescents, and young adults . Ewing sarcoma research is important for the research of a new treatment mode to improve the treatment outcome of Ewing sarcoma. Studies have reported that the most common mutations in Ewing sarcoma are the loss of function of STAG2, TP53, and CDKN2A genes . Moreover, some studies have also indicated that PIK3R1, NOTCH1, and CREBBP are common in recurrent Ewing sarcoma . The functional changes of TP53, PMS2, and RET genes are also important factors in inducing Ewing sarcoma .
The timeline of the cluster map of co-cited literature revealed that the treatment of Ewing sarcoma recently became a research hotspot. There are many treatment methods for Ewing sarcoma, including radiotherapy, surgery, chemotherapy, and targeted drug therapy. Ewing sarcoma is sensitive to radiation therapy, and preoperative neoadjuvant radiotherapy can shrink the tumor and reduce the risk of surgery [18, 19]. For metastasized tumors, radiotherapy can be used for treatment . Adjuvant chemotherapy with surgery or radiotherapy can significantly improve the survival rate of patients with Ewing sarcoma . Drugs, including ecteinascidin, cabozantinib, and regorafenib, have reported good efficacy in the treatment of Ewing sarcoma [22,23,24]. Likewise, the advancement of radiotherapy and targeted therapy has significantly improved the survival rate of pediatric and adolescent cancer patients.
Some limitations of this study should be addressed. WoSCC database is considered to be the most important data source for bibliometric analysis, so the only database used in this study. Hence, some studies might have been missed. In addition, only articles and reviews, as well as English-language publications, were used in the analysis, which might have led to some bias. Furthermore, the author's affiliation could not be fully established. Some authors might have duplicated names, or the same author could be from a different institution. That said, this study established research focus and emerging trends in Ewing sarcoma.
Availability of data and materials
All data generated or analyzed during this study are included in this published article.
Chen C, Borker R, Ewing J, et al. Epidemiology, treatment patterns, and outcomes of metastatic soft tissue sarcoma in a community-based oncology network. Sarcoma. 2014;2014: 145764.
Balamuth NJ, Womer RB. Ewing’s sarcoma. Lancet Oncol. 2010;11(2):184–92.
Bedük-Esen ÇS, Gültekin M, Aydın GB, et al. Ewing sarcoma in an infant and review of the literature. Turk J Pediatr. 2019;61(5):760–4.
Eaton BR, Claude L, Indelicato DJ, et al. Ewing sarcoma. Pediatr Blood Cancer. 2021;68(Suppl 2): e28355.
Zhou F, Zhang T, Jin Y, et al. Worldwide Tinnitus research: a bibliometric analysis of the published literature between 2001 and 2020. Front Neurol. 2022;13: 828299.
Zhou F, Zhang T, Jin Y, et al. Unveiling the knowledge domain and emerging trends of olfactory dysfunction with depression or anxiety: a bibliometrics study. Front Neurosci. 2022;8(16): 959936.
Zhou F, Zhang T, Jin Y, et al. Developments and emerging trends in the global treatment of chronic Rhinosinusitis from 2001 to 2020: a systematic bibliometric analysis. Front Surg. 2022;9: 851923.
Zhou F, Zhang T, Jin Y, et al. Emerging trends and research foci in allergic rhinitis immunotherapy from 2002 to 2021: a bibliometric and visualized study. Am J Transl Res. 2022;14(7):4457–76.
Da W, Tao Z, Meng Y, et al. A 10-year bibliometric analysis of osteosarcoma and cure from 2010 to 2019. BMC Cancer. 2021;21(1):115.
Ozaki T. Diagnosis and treatment of Ewing sarcoma of the bone: a review article. J Orthop Sci. 2015;20(2):250–63.
Morales E, Olson M, Iglesias F, et al. Role of immunotherapy in Ewing sarcoma. J Immunother Cancer. 2020;8(2): e000653.
Delattre O, Zucman J, Plougastel B, et al. Gene fusion with an ETS DNA-binding domain caused by chromosome translocation in human tumours. Nature. 1992;359(6391):162–5.
Boone MA, Taslim C, Crow JC, et al. Identification of a novel FUS/ETV4 fusion and comparative analysis with other Ewing sarcoma fusion proteins. Mol Cancer Res. 2021;19(11):1795–801.
Leavey PJ, Laack NN, Krailo MD, et al. Phase III trial adding vincristine-Topotecan-cyclophosphamide to the initial treatment of patients with Nonmetastatic Ewing sarcoma: a children’s oncology group report. J Clin Oncol. 2021;39(36):4029–38.
Sole A, Grossetête S, Heintzé M, et al. Tumorigenesis originating from patient-derived mesenchymal stem cells. Cancer Res. 2021;81(19):4994–5006.
Jagodzińska-Mucha P, Sobczuk P, Mikuła M, et al. Mutational landscape of primary and recurrent Ewing sarcoma. Contemp Oncol (Pozn). 2021;25(4):241–8.
Casey DL, Pitter KL, Wexler LH, et al. TP53 mutations increase radioresistance in rhabdomyosarcoma and Ewing sarcoma. Br J Cancer. 2021;125(4):576–81.
Lee ACW, Nathan SS, Chui CH, Lee KS. Treatment of Ewing sarcoma in children: results from a single centre. Ann Acad Med Singap. 2021;50(10):785–7.
Jagodzińska-Mucha P, Ługowska I, Świtaj T, et al. The clinical prognostic factors and treatment outcomes of adult patients with Ewing sarcoma. Int J Clin Oncol. 2020;25(11):2006–14.
van der Woude HJ, Bloem JL, et al. Osteosarcoma and Ewing’s sarcoma after neoadjuvant chemotherapy: value of dynamic MR imaging in detecting viable tumor before surgery. AJR Am J Roentgenol. 1995;165(3):593–8.
Muratori F, Totti F, Cuomo P, et al. Multimodal treatment in pelvic Ewing sarcoma: a prognostic factor analysis. Surg Technol Int. 2019;34:489–96.
Grohar PJ, Griffin LB, Yeung C, et al. Ecteinascidin 743 interferes with the activity of EWS-FLI1 in Ewing sarcoma cells. Neoplasia. 2011;13(2):145–53.
Schöffski P, Blay JY, Ray-Coquard I. Cabozantinib as an emerging treatment for sarcoma. Curr Opin Oncol. 2020;32(4):321–31.
Harrison DJ, Gill JD, Roth ME, et al. Initial in vivo testing of a multitarget kinase inhibitor, Regorafenib, by the pediatric preclinical testing consortium. Pediatr Blood Cancer. 2020;67(6): e28222.
This work was supported by National Natural Science Foundation (No.8217090607).
Ethics approval and consent to participate
Consent for publication
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Han, G., Liu, T. & Kang, P. Bibliometric analysis of Ewing sarcoma from 1993 to 2022. BMC Cancer 23, 272 (2023). https://doi.org/10.1186/s12885-023-10723-7
- Ewing sarcoma
- Bibliometric analysis