Department of Orthopedic Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China.
Ann Surg Oncol. 2022 Dec;29(13):8623-8630. doi: 10.1245/s10434-022-11912-7. Epub 2022 May 23.
Due to radical resection, endoprosthetic reconstruction (EPR) is more invasive and increases the risk of dislocation. Therefore, the suitability of EPR for elderly patients with metastatic tumor needs further investigation.
Seventy-one adult patients with isolated proximal femoral bone metastases who underwent EPR were retrospectively analyzed and stratified into two groups: elderly age group (≥60 years, n = 31) and younger age group (<60 years, n = 40). The effect of age on prognosis was analyzed to determine whether EPR is beneficial in elderly patients with proximal femoral metastatic tumor. Cox regression modeling was used to evaluate the effect of different factors on postoperative survival outcomes.
Ten (32.26%) and 9 (22.50%) cases of perioperative complications were recorded in the elderly and younger age groups, respectively, with median survival times of 22.00 ± 4.61 months and 23.00 ± 2.85 months, respectively; a log-rank test showed that the difference was not statistically significant (p = 0.657). A Cox regression model was established with patient age as the covariable to evaluate whether it affected postoperative survival. The risk of death due to age was not significant (p = 0.649), but malignancy and femoral metastasis type were significantly associated with postoperative survival (p = 0.001 and p = 0.019).
Although older patients have a slightly higher incidence of postoperative complications than younger patients, they do not experience severe adverse consequences. With rigorous selection and careful preparation, EPR is appropriate for the treatment of proximal femoral metastases in older patients, including those with Harrington type I-II acetabular invasion.
由于根治性切除，内假体重建（EPR）更具侵袭性，增加了脱位的风险。因此，EPR 对患有转移性肿瘤的老年患者的适用性需要进一步研究。
回顾性分析了 71 例接受 EPR 的孤立性股骨近端骨转移成人患者，并将其分为两组：老年组（≥60 岁，n=31）和年轻组（<60 岁，n=40）。分析年龄对预后的影响，以确定 EPR 是否对股骨近端转移性肿瘤的老年患者有益。Cox 回归模型用于评估不同因素对术后生存结果的影响。
老年组和年轻组分别有 10（32.26%）和 9（22.50%）例围手术期并发症，中位生存时间分别为 22.00±4.61 个月和 23.00±2.85 个月；对数秩检验显示差异无统计学意义（p=0.657）。建立了以患者年龄为协变量的 Cox 回归模型，以评估其是否影响术后生存。年龄导致死亡的风险无统计学意义（p=0.649），但恶性肿瘤和股骨转移类型与术后生存显著相关（p=0.001 和 p=0.019）。
尽管老年患者术后并发症的发生率略高于年轻患者，但他们并未经历严重的不良后果。通过严格选择和精心准备，EPR 适用于治疗老年股骨近端转移患者，包括 Harrington Ⅰ-Ⅱ型髋臼侵犯患者。
