Department of Orthopaedic Surgery, Leiden University Medical Center, The Netherlands.
Orthopedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Radiother Oncol. 2020 Mar;144:59-64. doi: 10.1016/j.radonc.2019.10.007. Epub 2019 Nov 14.
Patients with advanced cancer may develop painful bone metastases, potentially resulting in pathological fractures. Adequate fracture risk assessment is of key importance to prevent fracturing and maintain mobility. This study aims to validate the clinical reliability of axial cortical involvement with a 30 mm threshold on conventional radiographs to assess fracture risk in femoral bone metastases.
All patients with bone metastases who received radiotherapy for pain included in two multicentre prospective studies were selected. Conventional radiographs obtained at a maximum of two months prior to radiotherapy were collected. Three experts independently measured lesions and scored radiographic characteristics. Sensitivity, specificity, positive (PPV) and negative predictive value (NPV) were calculated.
Hundred patients were included with a median follow-up of 23.0 months (95%CI: 10.6-35.5). Two fractures occurred in lesions with axial cortical involvement <30 mm, and 12 in lesions ≥30 mm. Sensitivity, specificity, PPV and NPV of axial cortical involvement for predicting femoral fractures were 86%, 50%, 20% and 96%, respectively. Patients with lesions ≥30 mm had a 5.3 times higher fracture risk than patients with smaller lesions.
Our validation study confirmed the use of 30 mm axial cortical involvement to assess fracture risk in femoral bone metastases. Until a more accurate and practically feasible method has been developed, this clinical parameter remains an easy method to assess femoral fracture risk to aid patients and clinicians to choose the optimal individual treatment modality.
晚期癌症患者可能会发生疼痛性骨转移，从而导致病理性骨折。充分的骨折风险评估对于预防骨折和保持活动能力至关重要。本研究旨在验证常规 X 线片上 30mm 轴向皮质受累阈值评估股骨骨转移骨折风险的临床可靠性。
选择了在两项多中心前瞻性研究中接受放射治疗疼痛的所有骨转移患者。收集了放射治疗前最多两个月获得的常规 X 光片。三名专家独立测量病变并评分放射学特征。计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
共纳入 100 例患者，中位随访时间为 23.0 个月（95%CI：10.6-35.5）。2 例骨折发生在轴向皮质受累<30mm 的病变中，12 例发生在轴向皮质受累≥30mm 的病变中。轴向皮质受累预测股骨骨折的敏感性、特异性、PPV 和 NPV 分别为 86%、50%、20%和 96%。轴向皮质受累≥30mm 的患者骨折风险是皮质受累较小患者的 5.3 倍。
我们的验证研究证实了使用 30mm 轴向皮质受累来评估股骨骨转移的骨折风险。在开发出更准确和切实可行的方法之前，该临床参数仍然是评估股骨骨折风险的一种简便方法，有助于患者和临床医生选择最佳的个体化治疗方式。
