a Musculoskeletal Tumour Section, Department of Orthopaedic Surgery , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
b Paediatric section, Department of Orthopedic Surgery , Rigshospitalet, University of Copenhagen , Copenhagen , Denmark.
Acta Oncol. 2019 Apr;58(4):456-462. doi: 10.1080/0284186X.2018.1549368. Epub 2019 Jan 11.
The incidence of surgery due to metastatic bone disease in the extremities (MBDex) and postoperative survival remain uninvestigated in the population. The aim of the current study was: to identify (1) incidence, demographics and survival of a population-based cohort of patients having surgery for MBDex (2) rate of referrals and referral pattern to a musculoskeletal tumour centre (MTC).
A prospective study of a consecutive population-based cohort of patients having surgery for MBDex from 2014 to 2016. Patient demographics, indication for surgery, oncological status, and postoperative survival was obtained from patient interviews, surveillance scans and patient records.
We identified 164 patients treated for 175 bone lesions resulting in an incidence of MBDex surgery of 48.6 lesions/million inhabitants/year and a 10% risk of undergoing surgery for MBDex for every year liven with metastatic bone disease. The most common primary cancers were breast, lung, renal, prostate and myeloma. Twenty-nine lesions represented debut of cancer and 22 lesions debut of relapse of a previous cancer. Overall one-year survival was 41% (95% C.I.: 33%-48%). Fifty-nine percent of patients were referred for treatment at MTC. Patients referred had better prognostic baseline characteristic than patients treated at secondary surgical centres (SSC) (lower ASA score (p < .001), no visceral metastasis (p < .001), lower age (p < .001) and less aggressive primary cancer (p < .001)). The one-year probability of overall survival was higher for MTC patients compared to SSC patients (p < .001).
Present study describes a prospective population-based cohort of patients having surgery for MBDex identifying incidence and postoperative survival. Referral of patient is biased by selection where 'long-term survivors' are referred for treatment at MTC. We can, however, not exclude that treatment centre influences chance of survival after surgery for MBDex although our study was not designed to identify any potential influence.
四肢转移性骨病（MBDex）手术的发病率和术后生存率在人群中尚未得到研究。本研究的目的是：（1）确定 2014 年至 2016 年接受 MBDex 手术的基于人群的队列患者的发病率、人口统计学特征和生存率；（2）转诊率和转诊模式到肌肉骨骼肿瘤中心（MTC）。
对 2014 年至 2016 年接受 MBDex 手术的连续基于人群的队列患者进行前瞻性研究。通过患者访谈、监测扫描和患者记录获得患者的人口统计学特征、手术指征、肿瘤状态和术后生存率。
我们确定了 164 名患者治疗了 175 处骨病变，导致 MBDex 手术的发病率为 48.6 例/百万居民/年，并且每年因转移性骨病而接受 MBDex 手术的风险为 10%。最常见的原发性癌症是乳腺癌、肺癌、肾癌、前列腺癌和骨髓瘤。29 处病变代表癌症的首次发作，22 处病变代表先前癌症的首次复发。总体而言，一年生存率为 41%（95%置信区间：33%-48%）。59%的患者被转诊到 MTC 治疗。与在二级外科中心（SSC）治疗的患者相比，转诊患者具有更好的预后基线特征（较低的 ASA 评分（p<0.001），无内脏转移（p<0.001），较低的年龄（p<0.001）和侵袭性较低的原发性癌症（p<0.001））。与 SSC 患者相比，MTC 患者的一年总生存率更高（p<0.001）。
本研究描述了接受 MBDex 手术的患者的前瞻性基于人群的队列，确定了发病率和术后生存率。患者的转诊受到选择的影响，其中“长期幸存者”被转诊到 MTC 治疗。然而，我们不能排除治疗中心对 MBDex 手术后的生存机会有影响，尽管我们的研究不是为了确定任何潜在的影响而设计的。
