Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China.
BMC Cancer. 2023 Aug 24;23(1):795. doi: 10.1186/s12885-023-11292-5.
The aim of study was to evaluate survival outcome and limb function in cancer patients with proximal limbs metastasis. Associated factors on survival outcome and limb function were identified. The comparative analysis between intramedullary nailing and prosthesis surgery in cancer patients with proximal limb metastasis was performed.
In this five-center retrospective study, patients diagnosed with limbs metastasis were collected. Descriptive statistics was used and log-rank test was performed to analyze the survival in subgroups. The Cox proportional hazards regression analysis was performed to identify the independent prognostic factors. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate limb function after surgery, and t test or analysis of variance (ANOVA) was utilized in subgroup analysis.
A total of 316 patients with limb metastasis were included with mean age at 61.0 years. The most common primary tumor was breast, followed by renal cancer and lung cancer. The median overall survival was 24.0 months and the 1-, 3- and 5-year survival rates were 86.9%, 34.7% and 6.8%, respectively. Primary tumor type, visceral metastasis and chemotherapy were proved to be the independent prognostic factors. The mean Musculoskeletal Tumor Society (MSTS) score was 20.5, significant difference was observed in subgroup of solitary/multiple bone metastasis, with/without pathological fracture, and type of surgery.
The present study concluded that primary tumor type, visceral metastasis and chemotherapy were three factors affecting the survival of patients. Compared with intramedullary nailing, the patients underwent prosthesis surgery showed better limb function, this procedure should be encouraged in patients with indication.
本研究旨在评估伴肢体近端转移的癌症患者的生存结局和肢体功能，并确定影响生存结局和肢体功能的相关因素，同时对伴肢体近端转移的癌症患者行髓内钉内固定术和假体置换术的疗效进行比较分析。
本回顾性多中心研究共纳入 316 例肢体转移患者，采用描述性统计分析，对亚组进行生存分析采用 log-rank 检验，采用 Cox 比例风险回归分析识别独立预后因素。采用肌肉骨骼肿瘤学会（MSTS）评分系统评估术后肢体功能，亚组间采用 t 检验或方差分析（ANOVA）。
共纳入 316 例肢体转移患者，平均年龄为 61.0 岁，最常见的原发肿瘤为乳腺癌，其次为肾癌和肺癌。中位总生存期为 24.0 个月，1、3、5 年生存率分别为 86.9%、34.7%和 6.8%。原发肿瘤类型、内脏转移和化疗是独立的预后因素。MSTS 评分平均为 20.5，在单发/多发骨转移、有/无病理骨折和手术类型亚组间差异有统计学意义。
本研究表明，原发肿瘤类型、内脏转移和化疗是影响患者生存的三个因素。与髓内钉内固定术相比，假体置换术可使患者获得更好的肢体功能，对于适应证患者应鼓励采用该术式。
