Cappellari Alessandro, Trovarelli Giulia, Crimì Alberto, Pala Elisa, Angelini Andrea, Berizzi Antonio, Ruggieri Pietro
Department of Orthopedics and Orthopedic Oncology, University of Padova, Italy.
Department of Orthopedics and Orthopedic Oncology, University of Padova, Italy.
Injury. 2023 Mar;54 Suppl 1:S31-S35. doi: 10.1016/j.injury.2020.11.025. Epub 2020 Nov 11.
Long bone metastases are a disease of high social importance. The goals of surgical treatment are to relieve pain, maintain or restore joint function, and prevent or treat pathological fractures. "Oligometastases" is a disease with a limited number (3-5) of metastatic lesions in the same body district, where an aggressive treatment can be carried out with "curative" intent. This study aimed to evaluate patients with bone metastases surgically treated to determine how surgical treatment can influence prognosis and quality of life, comparing solitary metastasis, oligometastases, and multiple metastases.
This is a retrospective analysis of 130 patients with long bone metastases surgically treated between October 2015 and August 2019: 40 patients had solitary metastasis; 38 had less than three metastases (oligometastases), and 52 had multiple metastases. Surgery was resection and reconstruction with a cemented prosthesis (95) or nailing (35).
Overall survival was significantly better in patients with solitary metastasis or oligometastases than in those with multiple metastases (p <0.0001). Patients treated with resection and prosthesis had significantly better survival than those treated with nailing (p <0.0001). Implant complications requiring surgical revision occurred in 20 patients treated with prostheses, while no complications occurred in patients treated with nailing.
Survival of cancer patients has improved in the last two decades, leading to an increase of diagnosed metastases. Patients with oligometastases have a survival similar to those with a single metastasis. Optimal implants survival curves should stay above the curves of patients survival.
Since there are no differences in survival, patients with oligometastases should be treated as patients with a solitary lesion, with more aggressive surgery (wide resection and reconstruction with prosthesis). Intramedullary nailing is still indicated in metaphyseal or diaphyseal metastases in patients with advanced disease or poor prognosis when the life expectancy does not overcome the expected survival of the nail, avoiding the need for further surgery.
长骨转移瘤是一种具有高度社会重要性的疾病。外科治疗的目标是缓解疼痛、维持或恢复关节功能以及预防或治疗病理性骨折。“寡转移瘤”是指在同一身体区域内转移病灶数量有限（3 - 5个）的疾病，在此情况下可进行具有“治愈”意图的积极治疗。本研究旨在评估接受外科治疗的骨转移瘤患者，以确定手术治疗如何影响预后和生活质量，同时比较孤立性转移瘤、寡转移瘤和多发性转移瘤。
这是一项对2015年10月至2019年8月期间接受外科治疗的130例长骨转移瘤患者的回顾性分析：40例患者为孤立性转移瘤；38例患者转移灶少于3个（寡转移瘤），52例患者为多发性转移瘤。手术方式为使用骨水泥型假体进行切除和重建（95例）或髓内钉固定（35例）。
孤立性转移瘤或寡转移瘤患者的总生存期显著优于多发性转移瘤患者（p <0.0001）。接受切除和假体治疗的患者生存期显著优于接受髓内钉固定治疗的患者（p <0.0001）。接受假体治疗的20例患者发生了需要手术翻修的植入物并发症，而接受髓内钉固定治疗的患者未发生并发症。
在过去二十年中，癌症患者的生存期有所改善，导致诊断出的转移瘤数量增加。寡转移瘤患者的生存期与孤立性转移瘤患者相似。最佳的植入物生存曲线应高于患者生存曲线。
由于生存期无差异，寡转移瘤患者应被视为孤立性病灶患者，采用更积极的手术方式（广泛切除并用假体重建）。对于晚期疾病或预后较差、预期寿命不超过髓内钉预期生存期的患者，当干骺端或骨干转移瘤时，仍建议采用髓内钉固定，以避免进一步手术的需要。
