Shih Jen-Ta, Yeh Tsu-Te, Shen Pei-Hung, Wang Chih-Chien, Wang Sheng-Hao, Chien Wu-Chien, Chung Chi-Hsiang, Wu Chia-Chun
Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
Int J Gen Med. 2021 May 3;14:1661-1671. doi: 10.2147/IJGM.S307547. eCollection 2021.
With recent advances in surgical techniques and instruments, orthopedic surgeons are better equipped to treat metastatic bone disease. There has also been considerable progress in the non-surgical treatment of cancers, specifically in improving the survival rate of patients with advanced cancer. However, it remains unclear whether surgical resection of a metastatic bone lesion poses additional risk to the survival of patients with advanced cancer.
This study utilized data from the National Health Insurance Research Database (NHIRD) in Taiwan between 2000 and 2015. Patients aged ≥18 years, who had been recently diagnosed with bone metastases (BM), were enrolled and assigned to either the surgery or non-surgery groups. The demographic characteristics were analyzed, and the adjusted hazard ratios (aHR) of mortality were calculated using Cox regression analysis.
Of the 4,549,226 individuals in the inpatient database of the NHIRD, 83,536 patients with BM were enrolled in this study. Among them, 8802 underwent surgical resection for skeletal metastatic lesion and 66,098 did not. Altogether, 28,691 patients died, including 2798 (31.8%) in the surgery group and 25,893 (39.2%) in the non-surgery group. The aHR for mortality was 0.7-fold lower in the surgery group (p < 0.001).
This study demonstrates that surgical resection of metastatic bone lesions did not pose any additional risk to survival outcomes. Thus, we believe that surgery, if indicated, could have a competitive role in the management of metastatic bone disease.
随着外科技术和器械的最新进展，骨科医生在治疗转移性骨病方面有了更好的装备。癌症的非手术治疗也取得了相当大的进展，特别是在提高晚期癌症患者的生存率方面。然而，对于转移性骨病变的手术切除是否会给晚期癌症患者的生存带来额外风险仍不清楚。
本研究利用了台湾地区2000年至2015年国民健康保险研究数据库（NHIRD）的数据。纳入年龄≥18岁、最近被诊断为骨转移（BM）的患者，并将其分为手术组或非手术组。分析人口统计学特征，并使用Cox回归分析计算死亡率的调整风险比（aHR）。
在NHIRD住院数据库的4,549,226名个体中，有83,536名BM患者纳入本研究。其中，8802例因骨骼转移性病变接受了手术切除，66,098例未接受手术切除。共有28,691例患者死亡，其中手术组2798例（31.8%），非手术组25,893例（39.2%）。手术组的死亡率aHR低0.7倍（p<0.001）。
本研究表明，转移性骨病变的手术切除对生存结局没有带来任何额外风险。因此，我们认为，如果有指征，手术在转移性骨病的治疗中可以发挥有竞争力的作用。
