gms | German Medical Science

Objectives: Surgical therapy of bone metastases is becoming increasingly important due to prolonged life expectancy and improved oncological treatment measures. In a mostly palliative approach, it is necessary to identify those patients who might benefit from surgery. The shorter the remaining lifetime, the more restricted the indication and the less radical the intervention should be. The aim of this study was to evaluate the outcomes and prognostic factors in patients with surgically treated bone metastases.

Methods: We retrospectively investigated 140 patients with bone metastases in the appendicular skeleton who underwent 143 operations at our hospital between 2010 and 2020. Patient demographics, primary tumors, surgical procedures and subsequent complications were examined. Survival rate was calculated by Kaplan-Meier analysis. Prognostic factors were studied by univariate analysis using the long-rank test. Multivariate analysis was performed using Cox regression hazard model.

Results and Conclusion: The overall complication rate was 46,9%. The most common systemic complications were anemia requiring transfusion (9%), surgery-unrelated infections (7%) and worsening of the general condition (2%). The most common local complications were local progression (7%) fractures (3%) and nerve irritations (2%). Local infection occurred after only 1% of the operations. In the osteosynthetic group (92 operations), there was one reoperation (1%) after a fracture. In the endoprosthetic group (49 operations) three reoperations (6%) were performed due to local progress, fracture and dislocation.

For 138 patients, the mean postoperative survival was 30±3,6 months and the median survival was 12,4 months. The overall survival rates at 1, 2, 3 and 5 years were 53,3%, 38,2%, 28,4% and 18,2%, respectively. In the univariate analysis bronchial and renal cell carcinoma, pathological fracture, visceral metastases and multiple bone metastases were significantly associated with prognosis. No significant influence on the survival was determined for gender, age, location of bone metastasis, surgical procedure and time between tumor diagnosis and operation. Multivariate analysis confirmed that pathological fracture, visceral metastases and bronchial carcinoma were negative variables with regard to survival (p=0,002, p=0,000, p=0012).

Almost one out of five patients with appendicular skeletal metastasis achieved long-term survival after surgery. The study concluded that the presence of a pathological fracture, visceral metastases and bronchial carcinoma were independent prognostic factors for poor survival. These results should be considered in the decision-making process regarding a surgical treatment. It would be helpful to establish a score including all known prognostic factors to facilitate the choice of the best surgical procedure in each case.