From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument).
From the Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alta. (Abbott, Kendal, Hewison, Puloski, Monument); the McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alta. (Puloski, Monument); and the Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, Alta. (Monument)
Can J Surg. 2021 Nov 2;64(6):E550-E560. doi: 10.1503/cjs.015520. Print 2021 Nov-Dec.
Advances in systemic cancer therapies have improved survival for patients with metastatic carcinoma; however, it is unknown whether these advances have translated to improved survival for patients with appendicular metastatic bone disease (A-MBD) after orthopedic interventions. We conducted a study to evaluate the trend in overall survival for patients who underwent orthopedic surgery for A-MBD between 1968 and 2018.
A systematic search of Embase and Medline to identify studies published since 1968 evaluating patients treated with orthopedic surgery for A-MBD was conducted for a previously published scoping review. We used a meta-regression model to assess the longitudinal trends in 1-, 2- and 5-year overall survival between 1968 and 2018. The midpoint year of patient inclusion for each study was used for analysis. We categorized primary tumour types into a tumour severity score according to prognosis for a further meta-regression analysis.
Of the 5747 studies identified, 103 were retained for analysis. Meta-regression analysis showed no significant effect of midpoint study year on survival across all time points. There was no effect of the weighted average of tumour severity scores for each study on 1-year survival over time.
There was no significant improvement in overall survival between 1968 and 2018 for patients with A-MBD who underwent orthopedic surgery. Orthopedic intervention remains a poor prognostic variable for patients with MBD. This finding highlights the need for improved collection of prospective data in this population to identify patients with favourable survival outcomes who may benefit from personalized oncologic surgical interventions.
全身癌症治疗的进步提高了转移性癌患者的生存率；然而，尚不清楚这些进展是否转化为接受骨科干预的附肢转移性骨病（A-MBD）患者的生存改善。我们进行了一项研究，以评估 1968 年至 2018 年间接受骨科手术治疗 A-MBD 的患者的总体生存率趋势。
对 Embase 和 Medline 进行系统检索，以查找自 1968 年以来评估接受骨科手术治疗 A-MBD 的患者的研究，这是一项先前发表的范围综述的一部分。我们使用荟萃回归模型来评估 1968 年至 2018 年间 1 年、2 年和 5 年总体生存率的纵向趋势。每个研究的患者纳入的中点年份用于分析。我们根据预后将主要肿瘤类型分为肿瘤严重程度评分，以进行进一步的荟萃回归分析。
在确定的 5747 项研究中，有 103 项被保留用于分析。荟萃回归分析显示，在所有时间点，中点研究年份对生存率均无显著影响。随着时间的推移，每个研究的加权平均肿瘤严重程度评分对 1 年生存率也没有影响。
在接受骨科手术治疗的 A-MBD 患者中，1968 年至 2018 年间总体生存率没有显著改善。骨科干预仍然是 MBD 患者的预后不良变量。这一发现强调需要在该人群中更好地收集前瞻性数据，以确定具有有利生存结果的患者，他们可能受益于个性化的肿瘤外科干预。
