Saito Shiro, Kimura Hiroaki, Aiba Hisaki, Kawaguchi Yohei, Murakami Hideki
Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, JPN.
Cureus. 2024 Nov 10;16(11):e73382. doi: 10.7759/cureus.73382. eCollection 2024 Nov.
Background Bone metastases often cause pathological fractures and impair patients' quality of life and survival. Although several studies have been conducted on pathological fractures in the femur and spine, limited research has been done on the upper limbs. This study aimed to reveal the risk factors and determine how pathological fractures impact survival in patients with humeral metastasis. Methods This retrospective study was based on patients with humerus metastasis treated in the Nagoya-City University Hospital from 2010 to 2020. Patient characteristics, including sex, age at diagnosis of humeral metastasis, primary cancer, prior treatment, anatomical location, and metastatic lesion size, were retrieved from medical records. The patients were divided into pathological fracture and non-fracture groups, and their backgrounds and survival rates were compared. Results Of the 31 patients with 32 metastatic lesions included in this study, 19 had pathological fractures (one patient had bilateral fractures) and 12 had no fractures. Our analysis revealed that the risk factors for pathological fracture were treatment without bone-modifying agents, treatment without radiotherapy, and larger circumferential cortical involvement. The median overall survival was 21 months; 1-year survival was 56% in the non-fracture group and 59% in the fracture group. There was no significant difference in survival rates between the two groups and only chemotherapy correlated with longer survival in multivariate analysis. Conclusions Bone-modifying agents have the benefit of preventing pathological fractures due to humeral metastases. The humeral pathological fracture did not affect the patient's survival, and chemotherapy was the only prognostic factor that prolonged survival.
背景 骨转移常导致病理性骨折，损害患者的生活质量和生存期。尽管已经针对股骨和脊柱的病理性骨折开展了多项研究，但针对上肢的研究却很有限。本研究旨在揭示肱骨转移患者发生病理性骨折的危险因素，并确定病理性骨折对其生存期的影响。方法 本回顾性研究基于2010年至2020年在名古屋市立大学医院接受治疗的肱骨转移患者。从病历中获取患者特征，包括性别、肱骨转移诊断时的年龄、原发癌、既往治疗、解剖位置和转移灶大小。将患者分为病理性骨折组和非骨折组，比较两组患者的背景情况和生存率。结果 本研究纳入的31例有32处转移灶的患者中，19例发生病理性骨折（1例为双侧骨折），12例未发生骨折。我们的分析显示，病理性骨折的危险因素包括未使用骨改良剂治疗、未接受放疗以及较大范围的皮质周径受累。中位总生存期为21个月；非骨折组1年生存率为56%，骨折组为59%。两组生存率无显著差异，多因素分析中仅化疗与较长生存期相关。结论 骨改良剂有助于预防肱骨转移导致的病理性骨折。肱骨病理性骨折不影响患者生存期，化疗是延长生存期唯一的预后因素。
