Department of Therapeutic Radiology, Yale University School of Medicine.
Cancer Outcomes, Yale School of Medicine, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT.
Am J Clin Oncol. 2020 Oct;43(10):720-726. doi: 10.1097/COC.0000000000000737.
Pathologic fractures from bone metastases can significantly affect quality-of-life, although it is unclear which patients may be at high risk of this outcome. We aim to determine risk factors for pathologic fracture among patients admitted with bone metastases and to evaluate the association of pathologic fracture with clinical and economic outcomes.
The Healthcare Cost and Utilization Project National Inpatient Sample was queried for all patients hospitalized with bone metastases in 2016. Baseline differences between patients with and without pathologic fractures were assessed by χ and analysis of variance testing. Multivariable logistic regression was used to identify factors associated with fractures.
In 2016, 272,275 hospital admissions were associated with a diagnosis of bone metastases, of which 11,960 (4.4%) had a primary diagnosis of pathologic fracture. Patients with pathologic fractures had a longer length-of-hospital-stay (mean 7.5 vs. 6.4 d; P<0.001) and higher cost-of-hospital-stay (mean $23,611 vs. $15,942; P<0.001) compared to patients without pathologic fractures. Primary cancers associated with increased likelihood of pathologic fracture included liver and intrahepatic bile duct (odds ratio [OR] 2.34; 95% confidence interval [CI], 1.65-3.32), multiple myeloma (OR 1.94; 95% CI, 1.31-2.86), and kidney and renal pelvis cancer (OR 1.89; 95% CI, 1.50-2.37).
Nearly 5% of hospitalizations with bone metastases presented with a concomitant pathologic fracture, which was associated with longer inpatient stay and higher cost. Patients with hepatobiliary, renal cell carcinoma, or multiple myeloma, had a higher likelihood of pathologic fracture. These groups may benefit from increased outpatient monitoring, prophylactic stabilization, or early irradiation.
骨转移导致的病理性骨折会显著影响生活质量，但尚不清楚哪些患者有发生这种结果的高风险。本研究旨在确定因骨转移而住院的患者发生病理性骨折的危险因素，并评估病理性骨折与临床和经济结局的相关性。
本研究利用 2016 年全美住院患者医疗费用和利用项目数据库（Healthcare Cost and Utilization Project National Inpatient Sample），对所有因骨转移而住院的患者进行了查询。采用 χ²检验和方差分析评估有和无病理性骨折患者之间的基线差异。采用多变量逻辑回归确定与骨折相关的因素。
2016 年，共有 272275 例与骨转移相关的住院患者，其中 11960 例（4.4%）的主要诊断为病理性骨折。与无病理性骨折患者相比，病理性骨折患者的住院时间更长（平均 7.5 天 vs. 6.4 天；P<0.001），住院费用更高（平均 23611 美元 vs. 15942 美元；P<0.001）。与病理性骨折发生风险增加相关的主要癌症包括肝癌和肝内胆管癌（比值比 [OR] 2.34；95%置信区间 [CI]，1.65-3.32）、多发性骨髓瘤（OR 1.94；95% CI，1.31-2.86）和肾细胞癌和肾盂癌（OR 1.89；95% CI，1.50-2.37）。
近 5%的骨转移住院患者伴有并发的病理性骨折，这与住院时间延长和费用增加有关。患有肝胆癌、肾细胞癌或多发性骨髓瘤的患者发生病理性骨折的可能性更高。这些患者可能受益于增加门诊监测、预防性稳定或早期放疗。
