Wu Wei, Zhang Honghua, Fang Zhong, Li Feng
Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Transl Med. 2021 Jan;9(1):31. doi: 10.21037/atm-20-4764.
There is a heated debate on whether or not a late-stage cancer patient with bone metastasis should receive primary surgery. The aim was to assess whether primary tumor surgery in cancer patients with bone metastasis was associated with improved survival.
Cancer patients with bone metastasis were identified in the Surveillance, Epidemiology, and End Results database between 2010 and 2016. Overall survival and cancer-specific survival were compared between patients with and without primary tumor surgery using risk-adjusted Cox proportional hazard regression models and stratified propensity score methods. Further nomograms were constructed to predict personalized survival.
Overall, 22,631 cancer patients with synchronous bone metastasis were identified and the surgery rates were 33.3%, 76.3%, 42.0% and 2.0% for breast, bladder, renal and lung cancer, respectively. In Cox regression analysis after propensity score matching, primary cancer surgery was associated with a significantly improved overall survival for breast [hazard ratio (HR) =0.56], bladder (HR =0.69), lung (HR =0.61) and renal carcinoma (HR =0.37), while the prolonged median survival time was 20 months, 3 months, 4months and 21 months, respectively. Nomograms were constructed based on predictive factors, showing good consistency between the actual and predicted outcomes (C-index between 0.697 to 0.750) and feasibility in clinical practice.
This population-based cohort of cancer patients with bone metastasis supports primary tumor surgery as a significant protective factor for cancer patients with bone metastasis, and nomograms hold promise in assisting individualized risk stratification and accurate therapeutic strategy making.
对于骨转移晚期癌症患者是否应接受原发灶手术存在激烈争论。目的是评估骨转移癌症患者的原发肿瘤手术是否与生存改善相关。
在监测、流行病学和最终结果数据库中识别出2010年至2016年间的骨转移癌症患者。使用风险调整的Cox比例风险回归模型和分层倾向评分方法比较接受和未接受原发肿瘤手术患者的总生存和癌症特异性生存。构建进一步的列线图以预测个性化生存。
总体而言，共识别出22,631例同步骨转移癌症患者，乳腺癌、膀胱癌、肾癌和肺癌的手术率分别为33.3%、76.3%、42.0%和2.0%。在倾向评分匹配后的Cox回归分析中，原发癌症手术与乳腺癌（风险比[HR]=0.56）、膀胱癌（HR=0.69）、肺癌（HR=0.61）和肾癌（HR=0.37）的总生存显著改善相关，而延长的中位生存时间分别为20个月、3个月、4个月和21个月。基于预测因素构建列线图，显示实际和预测结果之间具有良好的一致性（C指数在0.697至0.750之间）且在临床实践中具有可行性。
这个基于人群的骨转移癌症患者队列支持原发肿瘤手术作为骨转移癌症患者的一个重要保护因素，并且列线图在协助个体化风险分层和准确制定治疗策略方面具有前景。
