Amouyel Thomas, Vieillard Marie-Hélène, Duhamel Alain, Maynou Carlos, Duterque-Coquillaud Martine, Dumont Cyrielle
Univ. Lille, CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 -CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France.
CHU Lille, Service d'Orthopédie 1, F-59000 Lille, France.
J Bone Oncol. 2024 Oct 10;49:100643. doi: 10.1016/j.jbo.2024.100643. eCollection 2024 Dec.
The main aim of this study was to analyse the 6-month survival rates in -acetabular metastasis patients undergoing total hip arthroplasty (THA) with an acetabular cage and without curettage. The secondary objectives were to analyse the global survival rates, the factors influencing patient survival and to evaluate mechanical complication rates after THA.
This study was carried out on a cohort of 93 consecutive patients who underwent THA with an acetabular cage without curettage for acetabular metastasis or multiple myeloma lesions between 2010 and 2020. The National Death Registry was consulted to obtain the exact date of death of the patients; the minimum follow-up time was 2 years.
The 6-month survival rate for all types of cancer was 78 % [68 - 85], the 1-year survival rate was 66 % [55 - 74], and the 5-year survival rate was 26 % [17 - 36]. The median overall survival for the cohort was 24.37 months [16.10 - 32.63]. The mean overall survival was 46.02 months [32.89 - 59.16]. At last contact, 86 % of the operated patients were walking again.No patient died from surgery. The ECOG performance status score, the number of bone metastatic sites, the presence of visceral metastases and the number of lines of systemic therapy undertaken prior to surgery were negative survival factors. Three patients (3.2 %) had early prosthetic dislocation, 2 patients (2.2 %) showed aseptic loosening of her partial hip implant after 10 and 11 years respectively and 4 patients (4.3 %) had an early infection treated by debridement, antibiotics and implant retention to control the infection. During the follow-up period, no new femoral metastases were detected in any patient.
Surgery without curettage is an effective treatment for periacetabular metastasis. It gives reliable results, regardless of the type of acetabular lesion, allowing most patients to walk again and does not modify the patient's survival.
本研究的主要目的是分析接受带髋臼笼且未进行刮除术的全髋关节置换术（THA）的髋臼转移患者的6个月生存率。次要目标是分析总体生存率、影响患者生存的因素，并评估THA后的机械并发症发生率。
本研究对2010年至2020年间连续93例因髋臼转移或多发性骨髓瘤病变接受带髋臼笼且未进行刮除术的THA患者进行了研究。查阅国家死亡登记处获取患者的确切死亡日期；最短随访时间为2年。
所有类型癌症的6个月生存率为78%[68 - 85]，1年生存率为66%[55 - 74]，5年生存率为26%[17 - 36]。该队列的中位总生存期为24.37个月[16.10 - 32.63]。平均总生存期为46.02个月[32.89 - 59.16]。在最后一次随访时，86%的手术患者再次能够行走。没有患者死于手术。东部肿瘤协作组（ECOG）体能状态评分、骨转移部位数量、内脏转移的存在以及手术前进行的全身治疗线数是负性生存因素。3例患者（3.2%）发生早期假体脱位，2例患者（2.2%）分别在10年和11年后出现部分髋关节假体无菌性松动，4例患者（4.3%）发生早期感染，通过清创、抗生素和保留假体进行治疗以控制感染。在随访期间，未在任何患者中检测到新的股骨转移。
不进行刮除术的手术是髋臼周围转移的有效治疗方法。无论髋臼病变类型如何，都能给出可靠的结果，使大多数患者能够再次行走，且不改变患者的生存率。
